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永久性大脑中动脉闭塞后再通延迟可促进大鼠功能恢复。

Delayed Recanalization Promotes Functional Recovery in Rats Following Permanent Middle Cerebral Artery Occlusion.

机构信息

Department of Physiology & Pharmacology, Loma Linda University School of Medicine, 11041 Campus St, Risley Hall Room 219, Loma Linda, CA, 92350, USA.

The Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.

出版信息

Transl Stroke Res. 2018 Apr;9(2):185-198. doi: 10.1007/s12975-018-0610-6. Epub 2018 Jan 21.

DOI:10.1007/s12975-018-0610-6
PMID:29354887
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6513323/
Abstract

Most large vessel stroke patients have permanent occlusion, for which there are no current treatment options. Recent case studies have indicated delayed recanalization, that is recanalization outside of the 6-h treatment window, may lead to improved outcome. We hypothesized that delayed recanalization will restore cerebral blood flow, leading to improved function in rats. Male SD rats were subjected to pMCAO or sham surgery. Delayed recanalization was performed on either day 3, 7, or 14 after pMCAO in a subset of animals. Cerebral blood flow was monitored during suture insertion, during recanalization, and then at sacrifice. Neurological function was evaluated for 1 week after delayed recanalization and at 4 weeks post-ictus. After sacrifice, cerebral morphology was measured. Compared to no treatment, delayed recanalization restored cerebral blood flow, leading to sensorimotor recovery, improved learning and memory, reduced infarct volume, and increased neural stem/progenitor cells within the infarction. The data indicate that earlier delayed recanalization leads to better functional and histological recovery. Yet, even restoring cerebral blood flow 14 days after pMCAO allows for rats to regain sensorimotor function. This exploratory study suggests that delayed recanalization may be a viable option for treatment of permanent large vessel stroke.

摘要

大多数大血管卒患者存在永久性闭塞，目前尚无治疗选择。最近的病例研究表明，延迟再通（即在 6 小时治疗窗口之外再通）可能导致改善预后。我们假设延迟再通将恢复脑血流，从而改善大鼠的功能。雄性 SD 大鼠接受大脑中动脉闭塞（pMCAO）或假手术。在一部分动物中，于 pMCAO 后第 3、7 或 14 天进行延迟再通。在缝线插入、再通期间和处死时监测脑血流。延迟再通后 1 周和中风后 4 周评估神经功能。处死大鼠后，测量脑形态。与未治疗相比，延迟再通恢复了脑血流，导致感觉运动恢复、学习和记忆改善、梗死体积减小以及梗死区内神经干细胞/祖细胞增加。数据表明，更早的延迟再通导致更好的功能和组织学恢复。然而，即使在 pMCAO 后 14 天恢复脑血流，大鼠也能恢复感觉运动功能。这项探索性研究表明，延迟再通可能是治疗永久性大血管卒中的一种可行选择。

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