Title Ischemic stroke reperfusion therapy window /
Translation of Title Ischemic Stroke Reperfusion Therapy Window.
Authors Tober, Marielena
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Pages 28
Keywords [eng] Stroke, wake-up stroke, unwitnessed onset, mismatch, brain imaging, stroke treatment methods, ischemic reperfusion therapy, extended time window, thrombolysis, thrombectomy, HDAC2
Abstract [eng] Acute ischemic stroke is a potential life-threatening condition, with an increasing risk in older patients. Presently, two evidence-based treatment methods are predominantly used: systemic thrombolysis with alteplase and mechanical thrombectomy. Intraarterial thrombolysis has been almost entirely replaced by mechanical thrombectomy. For both stroke therapy strategies, strict time windows are recommended. However, a lot of patients present beyond that limit or with unknown time of onset and therefore are not eligible to receive thrombolysis or endovascular therapy. Different studies hypothesized ways on how to prolong the time window. Therefore, brain imaging techniques such as computed tomography or magnetic resonance imaging are needed to show a mismatch between the ischemic core and the penumbra. This is crucial to select patients eligible for treatment in an extended time window. Prolongation of the time window, especially in case of treatment with systemic thrombolysis, might have additional side effects. These can be addressed via adjunctive therapy methods, among other things. Possible methods are presented and could be used as neuroprotective factors or to reduce hemorrhagic transformation due to thrombolysis. Evidence suggests that there are predictive factors for a good functional outcome in stroke patients, such as cerebral collateral blood flow and younger age. Nevertheless, pregnant women or children might also be affected by ischemic stroke. Special patient groups are excluded in a lot of studies, but still need attention so that there are sufficient guidelines on how to treat them. Lastly, a rather new target for therapy is described, which is the usage of HDAC2 inhibitors. This novel strategy might be of great importance in preventing secondary functional loss.
Dissertation Institution Vilniaus universitetas.
Type Master thesis
Language English
Publication date 2022