Neuroprotective delivery platforms as an adjunct to mechanical thrombectomy

Abstract

Despite the success of numerous neuroprotective strategies in animal and preclinical stroke models, none have effectively translated to clinical medicine. A multitude of influences are likely responsible. Two such factors are inefficient recanalization strategies for large vessel occlusions and suboptimal delivery methods/platforms for neuroprotective agents. The recent endovascular stroke trials have established a new paradigm for large vessel stroke treatment. The associated advent of advanced mechanical revascularization devices and new stroke technologies help address each of these existing gaps. A strategy combining effective endovascular revascularization with administration of neuroprotective therapies is now practical and could have additive, if not synergistic, effects. This review outlines past and current neuroprotective strategies assessed in acute stroke trials. The discussion focuses on delivery platforms and their potential applicability to endovascular stoke treatment.

Keywords: AIS = acute ischemic stroke; APC = activated protein C; BM-MNC = bone marrow mononuclear cell; DWI = diffusion-weighted imaging; MCA = middle cerebral artery; NIHSS = National Institutes of Health Stroke Scale; acute ischemic stroke; mRS = modified Rankin Scale; mechanical thrombectomy; neuroprotection; rPerC = remote ischemic perconditioning (preconditioning); tPA = tissue plasminogen activator.