title: [Brain protection against cerebral ischemia].
abstract: Previous clinical trials failed to show the benefit of several potentially protective drugs in acute ischemic stroke. However, there would be three main approaches for brain protection against stroke. The first is to develop a novel thrombolytic agent which is more efficient and safer than alteplase. Tenecteplase and desmoteplase are in progress as a new thrombolytic drug. The second strategy is to augment collateral circulation through leptomeningeal anastomosis. Administration of G-CSF could enhance arteriogenesis, but it takes several days to develop functional collateral. For this purpose, partial aortic balloon clumping or stimulation of pterygopalatine ganglion may be promising. The third one is to protect neurovascular unit against reperfusion injury. Brain hypothermia is the most effective strategy in experimental ischemia, and the clinical trial for hypothermia combined with thrombolysis therapy is in progress. Activation of endogenous protective response, as presented by ischemic tolerance, has focused on remote ischemic conditioning. Although the precise mechanisms of remote preconditioning remain unclear, intermittent limb ischemia is a safe approach. Remote ischemic conditioning is now investigated in acute patients with thrombolysis therapy.
authors.affiliation: Department of Neurology, Osaka Univeristy Graduate School of Medicine.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kitagawa
mesh_terms: D043925:Angiogenesis Inducing Agents; D001930:Brain Injuries / Q000209:etiology / Q000517:prevention & control*; D003097:Collateral Circulation; D055808:Drug Discovery; D005343:Fibrinolytic Agents; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000494:pharmacology; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods; D010960:Plasminogen Activators; D020521:Stroke / Q000150:complications / Q000628:therapy*; D000077785:Tenecteplase; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator
chemical_list: D043925:Angiogenesis Inducing Agents; D005343:Fibrinolytic Agents; C069588:salivary plasminogen activator alpha 1, Desmodus rotundus; D016179:Granulocyte Colony-Stimulating Factor; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator; D000077785:Tenecteplase