Advances in Ischemic Stroke Treatment: Current and Future Therapies

Abstract

This review summarizes current concepts in our understanding of stroke anatomy, pathophysiology of cerebral hypoperfusion, and collateral circulation. It also provides an evidence-based update in stroke trials and treatments assessed using PRISMA guidelines. Intravenous thrombolysis, endovascular thrombectomy for anterior circulation strokes, blood pressure control after endovascular thrombectomy, and medical management principles are discussed. Endovascular thrombectomy and medical therapy improves functional independence at 90 days in anterior circulation strokes even in late windows up to 24 h post symptom onset regardless of infarct core size. Intensive systolic blood pressure control acutely post thrombectomy is associated with harm and worse outcomes. This review also provides an evidence-based update on neurorehabilitation strategies with emerging interventions such as brain-computer interface and robotics having the potential to maximize neuroplasticity for potential improvement and recovery post stroke.

Keywords: Brain–body interactions; Collateral circulation; Endovascular thrombectomy; Evidence-based update; Stroke neurorehabilitation; Stroke syndromes; Stroke trials; Thrombolytic therapy.

Fig. 1

Stages of cerebral hypoperfusion