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Therapeutic management of ischemic stroke

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Abstract

Stroke is the third leading cause of years lost due to disability and the second-largest cause of mortality worldwide. Most occurrences of stroke are brought on by the sudden occlusion of an artery (ischemic stroke), but sometimes they are brought on by bleeding into brain tissue after a blood vessel has ruptured (hemorrhagic stroke). Alteplase is the only therapy the American Food and Drug Administration has approved for ischemic stroke under the thrombolysis category. Current views as well as relevant clinical research on the diagnosis, assessment, and management of stroke are reviewed to suggest appropriate treatment strategies. We searched PubMed and Google Scholar for the available therapeutic regimes in the past, present, and future. With the advent of endovascular therapy in 2015 and intravenous thrombolysis in 1995, the therapeutic options for ischemic stroke have expanded significantly. A novel approach such as vagus nerve stimulation could be life-changing for many stroke patients. Therapeutic hypothermia, the process of cooling the body or brain to preserve organ integrity, is one of the most potent neuroprotectants in both clinical and preclinical contexts. The rapid intervention has been linked to more favorable clinical results. This study focuses on the pathogenesis of stroke, as well as its recent advancements, future prospects, and potential therapeutic targets in stroke therapy.

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Abbreviations

HUK:

Human urinary kallidogenase

3K3A-APC:

Activated Protein Kinase C

NADPH:

Nicotinadime adenine dinucleotide phosphate

NMDA:

N-methyl-d-aspartate

AMPA:

α-Amino-3-hydroxy-5-methyl-4-isoxazolepropionc acid

AKT:

Protein kinase B

DAMP:

Damage-associated molecular patterns

BBB:

Blood brain barrier

DALY:

Disability associated life years

DNA:

Deoxyribonucleic acid

TXA2 :

Thromboxane A2

G P:

Glycoprotein

vWF:

Von Willebrand Factor

COX:

Cyclooxygenase

VTE:

Venous thromboembolism

ATP:

Adenosine triphosphate

BAX:

Bcl-2 Associated X-protein

BCL:

B-cell lymphoma-2

PKC:

Protein Kinase C

PAS:

A Per-Aent-Sim

TGF:

Transforming growth factor

TLR:

Toll-like receptor

TNF:

Tumor necrosis factor

ROCK:

Rho-associated protein kinase

NO:

Nitric Oxide

iNOS:

Inducible nitric oxide synthase

eNOS:

Endothelial nitric oxide synthase

nNOS:

Neuronal nitric oxide synthase

PKB:

Protein kinase B

LOO:

Lipid peroxyl radical

VNS:

Vagus Nerve stimulation

PAR:

Protease activated receptor

NLRP:

Nod-like receptor protein

TNK:

Tenecteplase

CNS:

Central Nervous System

MAPK:

Mitogen-activated protein kinase

MSCs:

Mesenchymal stem cell

IONPs:

Iron oxide nanoparticles

iPSC:

Induced pluripotent stem cell

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Acknowledgements

I would like to acknowledge the institution for making all the facilities required to finish this work.

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Authors and Affiliations

  1. Department of Pharmacology, ISF College of Pharmacy, Moga 142001, Affiliated to I.K Gujral Punjab Technical University, Jalandhar, Punjab, India

    Priya Bindal, Vishal Kumar, Lakshay Kapil & Arti Singh

  2. Department of Pharmaceutical Sciences, HNB Garhwal University (A Central University), Chauras Campus, Distt. Tehri Garhwal, Uttarakhand, 246174, India

    Charan Singh

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  1. Priya Bindal
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  2. Vishal Kumar
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  3. Lakshay Kapil
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  4. Charan Singh
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  5. Arti Singh
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Contributions

PB: writing original draft and preparation of figures. VK and LK: review and revision of the text. CS: critically review and editing. AS: conceptualization, supervision, critically review and editing. The authors confirm that no paper mill and artificial intelligence was used.

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Correspondence to Arti Singh.

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Highlights

• Within the scope of this study, we have focused on the pathophysiology of stroke, as well as the worldwide burden and statistics associated with it.

• We also brought attention to a limitation of the medications that are now available.

• We went over an overview of the many medications that are currently on the market, including their mechanisms of action, advantages, downsides, and limitations.

• Additionally, the novel tactics taken, as well as potential future treatment strategies, were discussed.

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Bindal, P., Kumar, V., Kapil, L. et al. Therapeutic management of ischemic stroke. Naunyn-Schmiedeberg's Arch Pharmacol 397, 2651–2679 (2024). https://doi.org/10.1007/s00210-023-02804-y

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  • DOI: https://doi.org/10.1007/s00210-023-02804-y

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