Schneider Anna M, Regenhardt Robert W, Dmytriw Adam A, Patel Aman B, Hirsch Joshua Adam, Buchan Alastair M
Acute Stroke Programme, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
J Neurol Neurosurg Psychiatry. 2023 Apr;94(4):267-271. doi: 10.1136/jnnp-2022-330379. Epub 2022 Dec 6.
Despite advances in clinical diagnosis and increasing numbers of patients eligible for revascularisation, ischaemic stroke remains a significant public health concern accounting for 3.3 million deaths annually. In addition to recanalisation therapy, patient outcomes could be improved through cerebroprotection, but all translational attempts have remained unsuccessful. In this narrative review, we discuss potential reasons for those failures. We then outline the diverse, multicellular effects of ischaemic stroke and the complex temporal sequences of the pathophysiological cascade during and following ischaemia, reperfusion, and recovery. This evidence is linked with findings from prior cerebroprotective trials and interpreted for the modern endovascular era. Future cerebroprotective agents that are multimodal and multicellular, promoting cellular and metabolic health to different targets at time points that are most responsive to treatment, might prove more successful.
尽管临床诊断取得了进展， eligible for revascularisation的患者数量也在增加，但缺血性中风仍然是一个重大的公共卫生问题，每年导致330万人死亡。除了再通治疗外，通过脑保护可以改善患者的预后，但所有的转化尝试都没有成功。在这篇叙述性综述中，我们讨论了这些失败的潜在原因。然后，我们概述了缺血性中风的多种多细胞效应，以及缺血、再灌注和恢复期间及之后病理生理级联反应的复杂时间顺序。这些证据与先前脑保护试验的结果相关联，并针对现代血管内治疗时代进行了解释。未来的脑保护剂如果是多模式、多细胞的，能够在对治疗最敏感的时间点促进不同靶点的细胞和代谢健康，可能会更成功。 （注：“eligible for revascularisation”此处翻译可能不太准确，建议补充更准确的表述以便完整理解整句含义）
