Reperfusion for acute ischemic stroke: arterial revascularization and collateral therapeutics.
OBJECTIVE
Reperfusion of the ischemic territory forms the basis of most acute stroke treatments. This overview of the literature relating to reperfusion in acute ischemic stroke published within the last year provides a snapshot of a rapidly evolving aspect of cerebrovascular disease.


RESULTS
Arterial revascularization from systemic thrombolysis to combination endovascular procedures to achieve recanalization has proliferated. Stroke imaging continues to discern features of critical pathophysiology that may influence tissue fate and clinical outcome. Balancing the risk of hemorrhagic transformation against the therapeutic aim to salvage the ischemic penumbra remains a formidable challenge. Collateral therapeutics that enhance perfusion outside the ischemic core present novel dimension to acute stroke therapy, focused on ischemia and not just the clot or plaque.


CONCLUSIONS
These timely findings illustrate the essential role of reperfusion in acute stroke, delineating aspects of arterial revascularization and collateral therapeutics to be refined in coming years.
Liebeskind
David S
DS
UCLA Stroke Center, Los Angeles, California 90095, USA. davidliebeskind@yahoo.com
D000208:Acute Disease; D001921:Brain / Q000098:blood supply / Q000473:pathology; D002545:Brain Ischemia / Q000473:pathology / Q000628:therapy*; D002548:Cerebral Revascularization / Q000379:methods*; D002560:Cerebrovascular Circulation; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008279:Magnetic Resonance Imaging; D015424:Reperfusion / Q000379:methods*
D005343:Fibrinolytic Agents