New directions in treatment of the ischemic stroke

Bartłomiej Zaremba, Adrianna Gorecka, Olga Wysokińska, Krystian Cholewa, Joanna Milanowska



Stroke remains a leading cause of death and disability worldwide. The cause is decrease or total blocking of blood perfusion in brain and fast recognition is essential to conduct proper treatment. Currently commonly used methods are thrombolysis and mechanical thrombectomy, which high efficacy is observed only if they are performed within a few hours of the first symptoms. Hence loads of people, who are diagnosed later, become unable to undergo effective treatment.

In the study are presented pathogenesis, epidemiology, classification, diagnosis and current treatment of the disease, but the main aim of the study is to present the results of the reports on new treatments for ischemic stroke. The research method is a review of the available literature published in PubMed, UpToDate and Google scholar databases.

In the study were reviewed new methods, which can be alternative for currently used ones. They are small molecules including fluoxetine, aripiprazole, L-DOPA, cholinergic and noradrenergic drugs, growth factors (HCG, EPO), monoclonal antibodies, allogenic stem cells, neurostimulators,  robotic therapy and telerehabilitation.

They give hope for curing a larger number of patients and improving effects of rehabilitation after ischemic stroke. However most of the methods, which are presented in this study require the use of tests that will allow checking their safety and application.


ischemic stroke; thrombolysis; thrombectomy; growth factors; brain stimulation

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Arshad Majid, MB, ChB, FRCPMounzer Kassab, M, Pathophysiology of ischemic stroke. (2020) Pobrane z: (17.03.2020r.)

Philip B. Gorelick, Stroke Prevention Therapy Beyond Antithrombotics: Unifying Mechanisms in Ischemic Stroke Pathogenesis and Implications for Therapy. Stroke 33 (2002) 862–875.

Hooman Kamel, Peter M. Okin, Mitchell S.V. Elkind, Costantino Iadecola, Atrial Fibrillation and Mechanisms of Stroke Time for a New Model. Stroke 47 (

(2016) 895-900.

Ivan Damjanov MD, PhD, What is decompression sickness? Hemodynamic disorders. Pathology Secrets (Third Edition), 71 (2009) 38-57.

Ahbeddou N, El Alaoui Taoussi K, Ibrahimi A, Ait Ben Haddou EH, Regragui W, Benomar A, Yahyaoui M, Stroke and syphilis: A retrospective study of 53 patients. Rev Neurol (Paris) 174 (5) (2018) 313-318.

Qian Li, Yang Yang, Cesar Reis,Tao Tao, Wanwei Li, Xiaogang Li, John H. Zhang, Cerebral Small Vessel Disease. Cell Transplant 27 (12) (2018) 1711–1722.

Kristian P Doyle, Roger P. Simon, and Mary P. Stenzel-Poore,Neuropharmacology – Special Issue on Cerebral Ischemia Mechanisms of Ischemic Brain Damage – Review Article. Neuropharmacology 55 (3) (2008) 310–318.

Jin-Moo Lee, Margaret C. Grabb, Gregory J. Zipfel, Dennis W. Choi, Brain tissue responses to ischemia. J Clin Invest 106 (6) (2000) 723–731.

Edson Bor-Seng-Shu, William S. Kita, Eberval G. Figueiredo, Wellingson S. Paiva, Erich T. Fonoff, Manoe J. Teixeira, Ronney B. Panerai, Cerebral hemodynamics: concepts of clinical importance. Arquivos de Neuro-Psiquiatria 70 (5) (2012)

Dunn IF, Ellegala DB, Fox JF, Kim DH. Principles of cerebral oxygenation and blood flow in the neurological critical care unit. Neurocrit Care 4 (2006) 77-82.

Kamel H, Iadecola C. Brain-immune interactions and ischemic stroke: clinical implications. Arch Neurol 69 (5) (2012) 576-81.

Claire L. Allen, Ulvi Bayraktutan, Risk Factors for Ischaemic Stroke. Int J Stroke 3 (2) (2008) 105-16.

Virani, Slim S., et al. Heart Disease and Stroke Statistics – 2020 Update: A Report From the American

Kalogeris, Theodore, et al. Ischemia/reperfusion. Comprehensive Physiology 7.1 (2010): 113-170.

Benjamin, Emelia J., et. al. Heart disease and stroke statistics – 2019 update: a report from the American Heart Association. Circulation (2019); 139.10: e56-e528.

Ovbiagele, Bruce, Mai N. Nguyen-Huynh. Stroke epidemiology: advancing our understanding of disease mechanism and therapy. Neurotherapeutics (2011);8.3: 319.

Daniel Václavík, Michal Bar, Lukáš Klečka, David Holeš, Martin Čábal, Robert Mikulík, Prehospital stroke scale (FAST PLUS Test) predicts patients with intracranial large vessel occlusion, Brain and Behaviour, Aug. 2018.

Janice Hinkle, The NIHSS for International Neuroscience Nurse, The Journal of Neurological and Neurosurgical Nursing 2014;3(3):97–144

Urs Fischer, Marcel Arnold, Krassen Nedeltchev, Caspar Brekenfeld, Pietro Ballinari, Luca Remonda, Gerhard Schroth, Heinrich P. Mattle, NIHSS Score and Arteriographic Findings in Acute Ischemic Stroke, Stroke. 2005;36:2121–2125

Li Khim Kwah, Joanna Diong, National Institutes of Health Stroke Scale (NIHSS), Journal of Physiotherapy, Volume 60, Issue 1, March 2014, Page 61

Bożena Sobkowicz, Sercowo-naczyniowe czynniki ryzyka udaru mózgu, Kardiologia po Dyplomie 2012; 11 (5): 41-52

Adams HP Jr,Bendixen BH,Kappelle LJ,Biller J,Love BB,Gordon DL,Marsh EE 3rd, Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment,Stroke. 1993 Jan;24(1):35-41.

Pei‐Hao Chen, Shan Gao, Yong‐Jun Wang, An‐Ding Xu, Yan‐Sheng Li, David Wang, Classifying Ischemic Stroke, from TOAST to CISS, CNS Neuroscience & Therapeutics, June 2012, pages 452-456

Kang DW,Chalela JA,Ezzeddine MA,Warach S, Association of ischemic lesion patterns on early diffusion-weighted imaging with TOAST stroke subtypes,Arch Neurol. 2003 Dec;60(12):1730-4.

Michael Marnane, Caroline A. Duggan, Orla C. Sheehan, Aine Merwick, Niamh Hannon, Denis Curtin, Dawn Harris, Emma B. Williams, Gillian Horgan, Lorraine Kyne, Patricia M.E. McCormack, Joseph Duggan, Alan Moore, Gloria Crispino-O'Connell, Peter J. Kelly, Stroke Subtype Classification to Mechanism-Specific and Undetermined Categories by TOAST, A-S-C-O, and Causative Classification System, Stroke. 2010;41:1579–1586

Negar Asdaghi, Thomas Jeerakathil, Bilal Hameed, Monica Saini, Jennifer A. McCombe, Ashfaq Shuaib, Derek Emery, Kenneth Butcher, Oxfordshire Community Stroke Project Classification Poorly Differentiates Small Cortical and Subcortical Infarcts, Stroke. 2011;42:2143–2148

Chen X, Shen Y, Huang C, et al Intravenous thrombolysis with 0.9 mg/kg alteplase for acute ischaemic stroke: a network meta-analysis of treatment delay Postgraduate Medical Journal Published Online First: 19 December 2019. doi: 10.1136/postgradmedj-2019-137121

G Thomalla, CZ Simonsen, F Boutitie, et al.MRI-guided thrombolysis for stroke with unknown time of onset N Engl J Med, 379 (2018), pp. 611-622

Bruce C V Campbell, Henry Ma, Peter A Ringleb, Mark W Parsons, Leonid Churilov, Martin Bendszus, Christopher R Levi, Chung Hsu, Timothy J Kleinig, Marc Fatar Extending thrombolysis to 4·5–9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data,The Lancet, Volume 394, Issue 10193,2019,Pages 139-147,ISSN 0140 6736,

Mayank Goyal, Bijoy K Menon, Wim H van Zwam, Diederik W J Dippel, Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials, The Lancet, Volume 387, Issue 10029, 2016, Pages 1723-1731, ISSN 0140-6736,

F. Chollet, J. Rigal, P. Marque, M. Barbieux-Guillot, N. Raposo, V. Fabry, J. F. Albucher, J. Pariente & I. Loubinoux, Serotonin Selective Reuptake Inhibitors (SSRIs) and Stroke,Current Neurology and Neuroscience Reports 100(2018).

Gillian E. Mead , Cheng-Fang Hsieh , Rebecca Lee , Mansur Kutlubaev , Anne Claxton , Graeme J. Hankey , Maree Hackett, Selective Serotonin Reuptake Inhibitors for Stroke Recovery, Stroke. 2013;44:844–850

David J. Lin , Seth P. Finklestein , Steven C. Cramer, New Directions in Treatments Targeting Stroke Recovery, Stroke. 2018;49:3107–3114

Steven C. Cramer, Drugs to Enhance Motor Recovery After Stroke, Stroke. 2015 Oct; 46(10): 2998–3005.

Kisho Obi, Izuki Amano, Yusuke Takatsuru, Role of dopamine on functional recovery in the contralateral hemisphere after focal stroke in the somatosensory cortex, Brain Research, Volume 1678, 1 January 2018, Pages 146-152

Farokhi-Sisakht F, Farhoudi M, Sadigh-Eteghad S, Mahmoudi J, Mohaddes G, Cognitive Rehabilitation Improves Ischemic Stroke-Induced Cognitive Impairment: Role of Growth Factors, J Stroke Cerebrovasc Dis. 2019 Oct;28(10):104299

Ludmila Belayev, Larissa Khoutorova, Karen L. Zhao, Allen W. Davidoff, Alan F.Moore, Steven C. Cramer, A novel neurotrophic therapeutic strategy for experimental stroke, Brain Research, Volume 1280, 14 July 2009, Pages 117-123

Ian N. Foltz , Margaret Karow , and Scott M. Wasserman, Evolution and Emergence of Therapeutic Monoclonal Antibodies, Circulation. 2013;127:2222–2230

Songlin Li, S. Thomas Carmichael, Growth-associated gene and protein expression in the region of axonal sprouting in the aged brain after stroke, Neurobiology of Disease, Volume 23, Issue 2, August 2006, Pages 362-373

Steven C. Cramer, Lori A. Enney, Colleen K. Russell, Monica Simeoni, Thomas R. Thompson, Proof-of-Concept Randomized Trial of the Monoclonal Antibody GSK249320 Versus Placebo in Stroke Patients, Stroke. 2017;48:692–698

David C Hess, Lawrence R Wechsler, Wayne M Clark, Sean I Savitz, Gary A Ford, David Chiu, Dileep R Yavagal, Ken Uchino, David S Liebeskind, Alexander P Auchus, Souvik Sen, Cathy A Sila, Jeffrey D Vest, Robert W Mays, Safety and efficacy of multipotent adult progenitor cells in acute ischaemic stroke (MASTERS): a randomised, double-blind, placebo-controlled, phase 2 trial, The Lancet Neurology 16 (5) (2017) 360-368.

Dheeraj Kalladka, John Sinden, Kenneth Pollock, Caroline Haig, John McLean, Wilma Smith, Alex McConnachie, Celestine Santosh, Philip M Bath, Laurence Dunn, Keith W Muir, Human neural stem cells in patients with chronic ischaemic stroke (PISCES): a phase 1, first-in-man study . The Lancet 388 (10046) (2016) 787-796

Gary K. Steinberg , Douglas Kondziolka, Lawrence R. Wechsler, L. Dade Lunsford, Maria L. Coburn, Julia B. Billigen, Anthony S. Kim, Jeremiah N. Johnson, Damien Bates, Bill King, Casey Case, Michael McGrogan, Ernest W. Yankee, and Neil E. Schwartz, Clinical Outcomes of Transplanted Modified Bone Marrow–Derived Mesenchymal Stem Cells in Stroke. A Phase 1/2a Study. Stroke 47 (2016) 1817-1824.

] Hany E. Marei, A. Hasan, R. Rizzi, A. Althani, N. Afifi, C. Cenciarelli, Thomas Caceci, and Ashfaq Shuaib, Potential of Stem Cell-Based Therapy for Ischemic Stroke. Frontiers in Neurology 9 (34) (2018).

Bornstein, Natan M., et al. An injectable implant to stimulate the sphenopalatine ganglion for treatment of acute ischaemic stroke up to 24 h onset (ImpACT-24B): an international, randomised, double-blind, sham-controlled, pivotal trial. The Lancet (2019); 394.10194: 219-229.

Janne M. Veerbeek, Anneli C. Langbroek-Amersfoort, Erwin E. H. van Wegen, Carel G. M. Meskers, Gert Kwakkel, Effects of Robot-Assisted Therapy for the Upper Limb After Stroke: A Systematic Review and Meta-analysis. Neurorehabilitation and Neural Repair 31 (2) (2016) 107-121.

Albert C. Lo, Peter D. Guarino, Lorie G. Richards, Jodie K. Haselkorn, George F. Wittenberg, Daniel G. Federman, Robert J. Ringer, Todd H. Wagner, Hermano I. Krebs, Bruce T. Volpe, Christopher T. Bever, Jr.,Dawn M. Bravata, Pamela W. Duncan, Barbara H. Corn, Alysia D. Maffucci, Stephen E. Nadeau, Susan S. Conroy, Janet M. Powell, Grant D. Huang, Peter Peduzzi, Robot-Assisted Therapy for Long-Term Upper-Limb Impairment after Stroke. The New England Journal of Medicine 362 (19) (2010) 1772-1783.

Bruce T. Volpe, Daniel Lynch, Avrielle Rykman-Berland, Mark Ferraro, Michael Galgano, Neville Hogan, Hermano I. Krebs, Intensive Sensorimotor Arm Training Mediated by Therapist or Robot Improves Hemiparesis in Patients With Chronic Stroke. Neurorehabil Neural Repair 22 (3) (2008) 305-10.

Verena Klamroth-Marganska, Javier Blanco, Katrin Campen, Armin Curt, Volker Dietz, Thierry Ettlin, Morena Felder, Bernd Fellinghauer, Marco Guidali, Anja Kolimar, Andreas Luft, Tobias Nef, Corina Schuster-Amft, Werner Stahel, Robert Riener, Three-dimensional, task-specific robot therapy of the arm after stroke: a multicentre, parallel-group randomised trial. The Lancet 13 (2) (2014) 132-133.

Todd H. Wagner , Albert C. Lo, Peter Peduzzi, Dawn M. Bravata, Grant D. Huang, Hermano I. Krebs, Robert J. Ringer, Daniel G. Federman, Lorie G. Richards, Jodie K. Haselkorn, George F. Wittenberg, Bruce T. Volpe, Christopher T. Bever, Pamela W. Duncan, Andrew Siroka, and Peter D. Guarino, An Economic Analysis of Robot-Assisted Therapy for Long-Term Upper-Limb Impairment After Stroke. Stroke 42 (9) (2011) 2630-2632.

Guger C., Allison B.Z., Mrachacz-Kersting N. (2019) Brain-Computer Interface Research: A State-of-the-Art Summary 7. In: Guger C., Mrachacz-Kersting N., Allison B. (eds) Brain-Computer Interface Research. SpringerBriefs in Electrical and Computer Engineering. Springer, Cham

Vourvopoulos A., Marin-Pardo O., Neureither M., Saldana D., Jahng E., Liew SL. (2019) Multimodal Head-Mounted Virtual-Reality Brain-Computer Interface for Stroke Rehabilitation. In: Chen J., Fragomeni G. (eds) Virtual, Augmented and Mixed Reality. Multimodal Interaction. HCII 2019. Lecture Notes in Computer Science, vol 11574. Springer, Cham

Fred S. Sarfo, Uladzislau Ulasavets, Ohene K. Opare-Sem, Bruce Ovbiagele, Tele-Rehabilitation after Stroke: An Updated Systematic Review of the Literature, Journal of Stroke and Cerebrovascular Diseases,Volume 27, Issue 9,2018,Pages 2306-2318, ISSN 1052-3057,

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