Ischemic stroke
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Understanding Ischemic Stroke: Pathophysiology, Risk Factors, and Treatment Advances
Pathophysiology of Ischemic Stroke
Ischemic stroke, the most common type of stroke, occurs due to the occlusion of a cerebral blood vessel, leading to brain infarction. The final infarct size and neurological outcome depend on various factors, including the duration and severity of ischemia, collateral circulation, systemic blood pressure, and patient-specific factors such as age, sex, comorbidities, and genetic background. The pathophysiology involves multiple cell death pathways, including apoptosis, necroptosis, autophagy, and ferroptosis, which contribute to neuronal death and brain damage.
Risk Factors and Global Burden
Ischemic stroke is influenced by numerous modifiable risk factors, including smoking, high body mass index (BMI), hypertension, hyperlipidemia, and atrial fibrillation. Age and sex also play critical roles, with aging being the strongest nonmodifiable risk factor. Men are more affected early in life, but the incidence and severity increase in women as they age. The global burden of ischemic stroke is significant, with deaths expected to rise from 3.29 million in 2019 to 4.90 million by 2030, particularly in low socio-demographic index regions.
Advances in Treatment Strategies
Early Recognition and Revascularization
Early recognition and treatment are crucial in reducing stroke-related morbidity and mortality. Intravenous thrombolysis with alteplase within 4.5 hours of symptom onset and early administration of aspirin are established treatments. Mechanical thrombectomy is increasingly applied, especially for large vessel occlusions .
Role of Stroke Units
Treatment in dedicated stroke centers significantly improves outcomes. These units provide specialized care, including close monitoring for complications and early intervention strategies, which are essential in the acute phase of stroke management .
Experimental Models and Nanomedicine
Experimental models, such as the endovascular suture model in rodents, help in understanding stroke pathophysiology and testing new treatments. Nanomedicine offers promising advancements by improving drug delivery to the brain, enhancing therapeutic effects, and reducing side effects .
Immune Response and Glial Cells
The post-stroke immune response, particularly the role of glial cells like microglia and astrocytes, is a new target for treatment. These cells can have both beneficial and detrimental effects, influencing inflammation and recovery processes.
Conclusion
Ischemic stroke remains a leading cause of disability and death worldwide. Understanding its complex pathophysiology, identifying and managing risk factors, and advancing treatment strategies are crucial in reducing its global burden. Early recognition, specialized stroke care, and innovative treatments like nanomedicine and immune modulation hold promise for improving outcomes in ischemic stroke patients.
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