Webinar on Neurovascular Disorders
Sprekers: Ed van Bavel & Michael D. Hill
Recorded on January 21, 2022
Reperfusion after Acute Ischemic Stroke: role of the cerebral microcirculation
Ed van Bavel, Professor of Vascular Biophysics, Amsterdam UMC, Department of Biomedical Engineering ad Physics, Scientific Integrity Counselor of Amsterdam UMC
Treatment of acute ischemic stroke due to occlusion of a large cerebral vessel has revolutionized by the introduction of mechanical thrombectomy in addition to enzymatic thrombolysis. Still, around 2/3 patients remain disabled or die. Infarcts may still grow after apparently successful clot removal. Impaired microvascular reperfusion could contribute to this. Ischemia and recanalization induce several microvascular and target tissue responses that affect the integrity of the microcirculation. These include local thrombo-inflammatory processes, blood-brain barrier breakdown and oedemic compression, and spasm of pericytes. I will discuss these processes, with focus on experimental studies and the still large gap between experimental findings and clinical relevance.
Michael D. Hill, MD MSc FRCPC, Professor at the Department of Clinical Neuroscience and at the Hotchkiss Brain Institute, University of Calgary and Foothills Medical Centre, President of the Canadian Neurological Sciences Federation.
The final nail was hammered into the coffin for “Stroke Neuroprotection” after the negative results of the SAINT-2 trial were released in 2007. Yes, cytoprotection of brain tissue is possible and used routinely after cardiac arrest using hypothermia. Cytoprotection may yet be possible in the new era of human ischemia reperfusion that has been made possible by endovascular thrombectomy (EVT). Nerinetide is a novel peptide that exhibits cytoprotective properties and is currently undergoing evaluation in phase 3 randomized clinical trials.