Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, 131 S. Robertson, Ste 1300, Room 1349, New Orleans, LA, 70112, USA.
School of Medicine, Tulane University, New Orleans, LA, 70112, USA.
Transl Stroke Res. 2023 Dec;14(6):863-889. doi: 10.1007/s12975-022-01100-w. Epub 2022 Nov 17.
Ischemic stroke presents a major global economic and public health burden. Although recent advances in available endovascular therapies show improved functional outcome, a good number of stroke patients are either ineligible or do not have access to these treatments. Also, robust collateral flow during acute ischemic stroke independently predicts the success of endovascular therapies and the outcome of stroke. Hence, adjunctive therapies for cerebral blood flow (CBF) enhancement are urgently needed. A very clear overview of the pial collaterals and the role of genetics are presented in this review. We review available evidence and advancement for potential therapies aimed at improving CBF during acute ischemic stroke. We identified heme-free soluble guanylate cyclase activators; Sanguinate, remote ischemic perconditioning; Fasudil, S1P agonists; and stimulation of the sphenopalatine ganglion as promising potential CBF-enhancing therapeutics requiring further investigation. Additionally, we outline and discuss the critical steps required to advance research strategies for clinically translatable CBF-enhancing agents in the context of acute ischemic stroke models.
缺血性脑卒中是全球范围内重大的经济和公共卫生负担。尽管目前的血管内治疗方法取得了进展，可改善患者的功能预后，但仍有相当一部分脑卒中患者不适合或无法接受这些治疗。此外，急性缺血性脑卒中时良好的侧支循环血流独立预测血管内治疗的效果和脑卒中的结局。因此，迫切需要增强脑血流（CBF）的辅助治疗。本文综述了软脑膜侧支循环及其遗传学作用的最新研究进展。我们回顾了目前在急性缺血性脑卒中期间提高 CBF 的潜在治疗方法的相关证据和进展。我们发现无血红素可溶性鸟苷酸环化酶激活剂；Sanguinate、远程缺血预处理；法舒地尔、S1P 激动剂；以及刺激蝶腭神经节可能是有前途的、需要进一步研究的 CBF 增强治疗方法。此外，我们还概述并讨论了在急性缺血性脑卒中模型中推进具有临床转化潜力的 CBF 增强剂研究策略所需的关键步骤。
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