Cerebroprotection for Acute Ischemic Stroke

The availability of mechanical thrombectomy (MT) in clinical practice has improved acute stroke outcome and allowed to understand the role played by reperfusion in mediating brain injury. Rapid reperfusion of ischemic penumbra is critical to neurological recovery, however, it can also lead to reperfusion injury induced by high levels of free oxygen radicals, reactive hyperemia and proinflammatory state thrombosis.

Therefore, the rates of excellent outcome or functional independence following MT performed in both the early and late time window, in clinical trials, or in clinical practice are far from satisfactory compared with the very high rates of successful recanalization which implies the need to further improve recovery of patients.

Recanalization therapy constitutes a novel opportunity for cytoprotective agents due to a higher chance to reach the ischemic penumbra and to protect from the injury and death of neurons after ischemia-reperfusion. Success in developing cerebroprotection, either as an adjunct to recanalization or as stand-alone treatment will require new focus on pleiotropic agents that act via multiple mechanisms of action and target different components of the neurovascular unit.

Cerebrolysin is a neurotrophic peptidergic preparation with broad cytoprotective properties, recommended by the European Academy of Neurology and European Federation of Neurorehabilitation Societies for both the acute- and poststroke rehabilitation.

Preclinical and clinical studies suggest that Cerebrolysin as an add-on therapy to reperfusion therapy may improve stroke outcome by initiating cytoprotective effects and preventing reperfusion injury. Potential targets for cerebroprotection and preliminary data of Cerebrolysin in acute stroke treatment will be discussed during the presentation.