Department of Biomedical Engineering and Physics, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Molecular Cell Biology and Immunology, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Fluids Barriers CNS. 2021 Oct 19;18(1):46. doi: 10.1186/s12987-021-00280-1.
With the introduction of endovascular thrombectomy (EVT), a new era for treatment of acute ischemic stroke (AIS) has arrived. However, despite the much larger recanalization rate as compared to thrombolysis alone, final outcome remains far from ideal. This raises the question if some of the previously tested neuroprotective drugs warrant re-evaluation, since these compounds were all tested in studies where large-vessel recanalization was rarely achieved in the acute phase. This review provides an overview of compounds tested in clinical AIS trials and gives insight into which of these drugs warrant a re-evaluation as an add-on therapy for AIS in the era of EVT. A literature search was performed using the search terms "ischemic stroke brain" in title/abstract, and additional filters. After exclusion of papers using pre-defined selection criteria, a total of 89 trials were eligible for review which reported on 56 unique compounds. Trial compounds were divided into 6 categories based on their perceived mode of action: systemic haemodynamics, excitotoxicity, neuro-inflammation, blood-brain barrier and vasogenic edema, oxidative and nitrosative stress, neurogenesis/-regeneration and -recovery. Main trial outcomes and safety issues are summarized and promising compounds for re-evaluation are highlighted. Looking at group effect, drugs intervening with oxidative and nitrosative stress and neurogenesis/-regeneration and -recovery appear to have a favourable safety profile and show the most promising results regarding efficacy. Finally, possible theories behind individual and group effects are discussed and recommendation for promising treatment strategies are described.
随着血管内血栓切除术(EVT)的引入,急性缺血性脑卒中(AIS)的治疗进入了一个新时代。然而,尽管与单独溶栓相比,再通率大大提高,但最终结果仍远不理想。这就提出了一个问题,即以前测试过的一些神经保护药物是否需要重新评估,因为这些化合物都是在急性阶段很少实现大血管再通的研究中进行测试的。本综述概述了在临床试验中测试的化合物,并深入探讨了其中哪些药物作为 EVT 时代的 AIS 附加治疗需要重新评估。使用搜索词“缺血性脑卒中脑”在标题/摘要中进行了文献检索,并使用了其他过滤器。根据预先定义的选择标准排除论文后,共有 89 项试验符合审查条件,报告了 56 种独特的化合物。根据其预期作用模式将试验化合物分为 6 类:全身血液动力学、兴奋性毒性、神经炎症、血脑屏障和血管源性水肿、氧化和硝化应激、神经发生/再生和恢复。总结了主要试验结果和安全性问题,并突出了有重新评估前景的有前途的化合物。从组效应来看,干预氧化和硝化应激以及神经发生/再生和恢复的药物似乎具有良好的安全性,并在疗效方面显示出最有前途的结果。最后,讨论了个体和组效应背后的可能理论,并描述了有前途的治疗策略的建议。