Ischemic Stroke

Stroke due to BRAIN ISCHEMIA resulting in interruption or reduction of blood flow to a part of the brain. When obstruction is due to a BLOOD CLOT formed within in a cerebral blood vessel it is a thrombotic stroke. When obstruction is formed elsewhere and moved to block a cerebral blood vessel (see CEREBRAL EMBOLISM) it is referred to as embolic stroke. Wake-up stroke refers to ischemic stroke occurring during sleep while cryptogenic stroke refers to ischemic stroke of unknown origin.

Also Known As:

Acute Ischemic Strokes; Cryptogenic Embolism Strokes; Cryptogenic Ischemic Strokes; Cryptogenic Strokes; Embolism Stroke, Cryptogenic; Ischaemic Strokes; Ischemic Stroke, Acute; Ischemic Stroke, Cryptogenic; Ischemic Strokes; Stroke, Acute Ischemic; Stroke, Cryptogenic; Stroke, Cryptogenic Embolism; Stroke, Cryptogenic Ischemic; Stroke, Ischaemic; Stroke, Ischemic; Stroke, Wake-up; Wake up Stroke; Wake-up Strokes; Acute Ischemic Stroke; Cryptogenic Embolism Stroke; Cryptogenic Ischemic Stroke; Cryptogenic Stroke; Ischaemic Stroke; Wake-up Stroke

Networked: 34073 relevant articles (2836 outcomes, 7785 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Stroke (Strokes)
2.	Atrial Fibrillation
3.	Myocardial Infarction
4.	Infarction (Infarctions)
5.	Hemorrhage

Experts

1.	Saver, Jeffrey L: 224 articles (03/2022 - 01/2002)
2.	Wang, Yongjun: 192 articles (11/2022 - 01/2006)
3.	Lip, Gregory Y H: 152 articles (09/2022 - 12/2004)
4.	Liebeskind, David S: 146 articles (06/2022 - 01/2002)
5.	Hill, Michael D: 141 articles (11/2022 - 01/2002)
6.	Wang, Yilong: 135 articles (11/2022 - 01/2006)
7.	Nogueira, Raul G: 123 articles (12/2022 - 10/2004)
8.	Goyal, Mayank: 122 articles (12/2022 - 10/2010)
9.	Tsivgoulis, Georgios: 120 articles (08/2022 - 12/2004)
10.	Schwamm, Lee H: 116 articles (10/2022 - 04/2002)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Ischemic Stroke:

1.	Tissue Plasminogen Activator (Alteplase)FDA Link 09/01/2009 - "The submitted clinical evidence included several randomised controlled trials indicating that, in highly selected patients, alteplase administered at a licensed dose within 3 hours of the onset of acute ischaemic stroke is associated with a statistically significant reduction in the risk of death or dependency at 3 months compared with placebo, despite a significantly increased risk of symptomatic intracranial haemorrhage within the first 7-10 days. " 01/01/2020 - "Assuming an acute ischemic stroke as the most likely diagnosis, alteplase (tPA) was administered 3 h after symptoms onset, however without any improvement in patient symptoms. " 01/01/2020 - "Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) is the established treatment for acute ischemic stroke and has been highly effective in reducing the neurological deficit. " 07/01/2016 - "Although recombinant tissue plasminogen activator (r-tPA) is currently the most effective treatment for brain ischemic stroke, the 3-h narrow therapeutic windows severely limits its clinical efficacy. " 01/01/2014 - "The efficacy of alteplase in acute ischaemic stroke (AIS) is highly time dependent. "
2.	Aspirin (Acetylsalicylic Acid)FDA LinkGeneric 04/01/2017 - "Presently, the only antithrombotic drug treatment that has proven effective at improving acute ischemic stroke patient outcome is aspirin administration. " 05/01/2010 - "To evaluate the efficacy of aspirin for the treatment and prevention of ischemic stroke and identify the minimum dose proven to be effective for each indication. " 01/01/2023 - "Aspirin did not produce a statistically significant reduction in the incidence of ischemic stroke (hazard ratio [HR], 0.89; 95% CI, 0.71-1.11). " 01/01/2011 - "Aspirin has been reported to be less effective for secondary vascular prevention in patients with ischaemic stroke, compared with other high-risk populations. " 06/01/2005 - "The antiplatelet efficacy of aspirin was examined in all patients with ACS, as well as in 69 individuals who had suffered ischemic stroke and in 58 high-risk subjects without any known ischemic vascular events. "
3.	Neuroprotective AgentsIBA 01/01/2018 - "Based on these findings, we propose that brain-penetrant MCU inhibitors have strong potential to be well-tolerated and highly-efficacious neuroprotectants for the acute management of ischemic stroke." 12/01/2023 - "However, very few neuroprotective agents have shown promise for treatment of ischemic stroke in clinical trials, despite showing efficacy in many successful preclinical studies. " 01/01/2017 - "Various animal models of ischemic stroke have proven efficacy of many neuroprotective agents without any considerable result in phase III clinical trials. " 01/28/2013 - "While many neuroprotective agents have been proven effective in a variety of animal ischemic stroke models, none have been shown to work in phase III clinical trials. " 03/15/2010 - "However, at present, no neuroprotective agent has proven effective in focal ischemic stroke phase III trials, despite the encouraging data in animal models. "
4.	Warfarin (Coumadin)FDA LinkGeneric 01/01/2018 - "This study using collective warfarin data from recent large prospective trials indicates that INR between 2 and 2.5 provides the best balance between ischemic stroke and ICH, as well as optimal protection against death in patients with AF." 10/01/2012 - "In the general population, warfarin is highly effective for prophylaxis of ischaemic stroke, and though warfarin use likely increases the risk of intracranial haemorrhage, the absolute increase in risk is small. " 01/01/2008 - " summary, warfarin is highly effective in preventing ischaemic strokes in White patients with AF at a modestly higher risk of ICH. " 08/01/2014 - "After adjusting for CHADS2 score, warfarin use was not associated with a significant reduction in ischemic stroke events [hazard ratio (HR) 3.36; 95 % confidence interval (CI) 0.94-11.23]. " 01/01/2023 - "DOACs may be more effective in preventing ischemic stroke than warfarin in patients with AF and AS. "
5.	Clopidogrel (Plavix)FDA Link 01/01/2003 - "The MATCH trial is currently being conducted to test the hypothesis that long-term administration of clopidogrel on top of ASA is superior to clopidogrel alone for the reduction of major ischaemic events in patients with recent TIA or ischaemic stroke who are at high risk of atherothrombotic recurrence. " 12/01/2022 - "Verifynow P2Y12 PRU-guided modification of clopidogrel for ischemic stroke significantly improved or prevented recurrence at the 1-year follow-up. " 01/01/2016 - "To study the safety and efficacy of a clopidogrel loading dose in patients with moderate and severe acute ischemic strokes. " 01/01/2016 - "Safety and Efficacy of Acute Clopidogrel Load in Patients with Moderate and Severe Ischemic Strokes." 10/09/2023 - "There are few studies on the relationship between the occurrence of clopidogrel-related high residual platelet reactivity (HRPR) and estimated glomerular filtration rate (eGFR) at admission in patients with ischemic stroke. "
6.	Hydroxymethylglutaryl-CoA Reductase Inhibitors (HMG-CoA Reductase Inhibitors)IBA 05/01/2002 - "Large prevention studies show HMG-CoA reductase inhibitors significantly decreased major coronary events in the elderly similar to that observed in the younger people, and were also effective in preventing ischemic stroke. " 01/01/2009 - "Previous treatment with statins is an independent factor associated with good outcomes in patients with ischaemic stroke. " 05/01/2004 - "Statins may be beneficial for patients with acute ischemic stroke. " 11/01/2014 - "Statin use during hospitalization is associated with improved survival and a better discharge disposition among patients with ischemic stroke. " 01/01/2012 - "Statin use before ischemic stroke hospitalization was associated with improved survival (hazard ratio, 0.85; 95% CI, 0.79-0.93; P<0.001), and use before and during hospitalization was associated with better rates of survival (hazard ratio, 0.59; 95% CI, 0.53-0.65; P<0.001). "
7.	AnticoagulantsIBA 01/01/2004 - "In some cases, anticoagulants may be effective in preventing ischaemic stroke recurrence. " 12/01/2023 - "In our study, we performed a propensity-matched analysis to investigate the safety and efficacy of MT in patients with acute ischemic stroke receiving anticoagulants. " 02/01/2023 - "NOACs have indeed improved anticoagulants use in patients with acute ischemic stroke and NVAF at discharge. " 11/15/2022 - "The safety and efficacy of periprocedural intravenous anticoagulants for acute ischemic stroke patients who underwent endovascular treatment: Sub-analysis of the RESCUE-Japan Registry 2." 01/01/2023 - "The aim of the present study was to investigate whether the risk of MI and ischemic stroke differs between individuals with first-diagnosed paroxysmal vs. non-paroxysmal AF treated with anticoagulants. "
8.	Tirofiban (Aggrastat)FDA Link 12/01/2022 - "Safety and efficacy of different tirofiban administration routes on acute ischemic stroke patients with successful recanalization: A propensity score matching analysis." 11/17/2023 - "In a previously published clinical trial, we demonstrated that tirofiban was effective and safe in acute ischemic stroke (AIS) patients who did not undergo early recanalization treatments. " 01/01/2023 - "To investigate whether preceding intravenous thrombolysis combined with tirofiban in patients with acute ischemic stroke undergoing endovascular treatment is safe and effective. " 02/01/2010 - "In spite of the fact that the null hypothesis was not supported by our data, we found results supporting the safety (and potential efficacy) of ASA and tirofiban when used in the first hours of acute ischemic stroke. " 06/01/2023 - "Analysis of risk factors for the efficacy of tirofiban in the treatment of acute ischemic stroke."
9.	Fibrinolytic Agents (Antithrombotic Agents)IBA 06/01/2018 - "Studies delineating and refining the interval before thrombolytic agent administration in ischemic stroke have dramatically reduced the door-to-needle time. " 01/01/2021 - "Hundreds of clinical trials have proven ineffective in bringing forth a definitive and effective treatment for ischemic stroke, except a myopic class of thrombolytic drugs. " 01/01/1998 - "Intraarterial delivery of a thrombolytic agent has yet to be proven effective and safe in improving long-term outcome of ischemic stroke patients. " 01/01/2004 - "Recent clinical trials have suggested that other antithrombotic agents may be beneficial in acute ischemic stroke. " 10/01/2013 - "Trials conducted to study the efficacy of thrombolytic drug reported better outcome with use of thrombolytic drug but none studied the subtypes of ischemic strokes specifically and adequately. "
10.	EdaravoneIBA 01/01/2023 - "As a proof of concept, intrinsic strain-mediated ultrathin ceria nanoplates could boost antioxidation for improved ischemic stroke treatment in vivo, significantly better than edaravone, a commonly used clinical drug." 01/01/2022 - "Edaravone is a promising treatment for ischemic stroke patients, with a more favorable time window. " 01/01/2019 - "Conclusions- For any ischemic stroke subtype, edaravone use (compared with no use) was associated with a greater improvement in neurological symptoms, although the difference was small (<1 point NIHSS) and of limited clinical significance." 12/01/2021 - "In conclusion, the results of the present study demonstrated that NBP and edaravone effectively prevented ischemic stroke damage with multi‑target protective effects. " 12/01/2021 - "The aim of the present study was to explore whether the co‑administration of NBP and edaravone had multi‑target protective effects on the neurovascular unit (NVU) of mice affected by ischemic stroke. "

Therapies and Procedures

1.	Therapeutics 01/01/2021 - "Although many therapies have been shown to be effective in preclinical studies of ischemic stroke, almost none of them passed clinical trials, and the reasons for most failures have not been well identified. " 08/08/2023 - "Vascular recanalization therapy has been proven to be one of the most effective treatments for acute ischemic stroke (AIS) worldwide. " 08/05/2023 - "Recanalization therapy is the most effective treatment for eligible patients with acute ischemic stroke (AIS). " 01/01/2023 - "Reperfusion therapy is the most effective treatment for acute ischemic stroke but remains underused in China. " 01/01/2023 - "This protocol aims to evaluate the safety and efficacy of a non-invasive, extremely low-frequency, low-intensity, frequency-tuned electromagnetic field treatment [Electromagnetic Network Targeting Field (ENTF) therapy] in reducing disability and promoting recovery in people with subacute ischemic stroke (IS) with moderate-severe disability and upper extremity (UE) motor impairment. "
2.	Thrombectomy 04/01/2019 - "In randomized clinical trials, mechanical thrombectomy (MT) was proved to be a highly effective treatment of acute ischemic stroke which improved clinical outcomes. " 01/01/2019 - "Conclusions- Matched patient analysis across randomized trials provides evidence that the strategy of combined IVT and mechanical thrombectomy is a highly beneficial treatment strategy for acute ischemic stroke caused by large vessel occlusion patients. " 04/14/2015 - "Mechanical thrombectomy in select patients with acute ischemic stroke and proximal artery occlusions has demonstrated substantial rates of partial or complete arterial recanalization and improved outcomes compared with IV rtPA or best medical treatment alone in multiple randomized clinical trials. " 10/12/2023 - "Mechanical thrombectomy (MT) associated with the best medical treatment (BMT) has recently shown efficacy for the management of acute ischemic stroke (AIS) secondary to a large vessel occlusion. " 09/01/2023 - "Mechanical thrombectomy (MT) is a highly effective treatment for acute ischemic stroke, and hemorrhagic complications caused by vessel injury are rare. "
3.	Thrombolytic Therapy 12/01/2010 - "Only the latter has been proven to be effective in larger randomized trials and is a Class 1/Level A recommendation in national or international guidelines.(1) This review summarizes the evidence for thrombolytic therapy of acute ischemic stroke with emphasis on progress regarding the approved intravenous treatment. " 01/01/2016 - "Systemic thrombolytic therapy (STLT) is an available method of treatment of ischemic stroke (II) with proven efficacy. " 07/01/2015 - "Thrombolytic therapy has been proven to be effective in acute ischemic stroke treatment and shown to improve long-term functional outcomes. " 09/01/2009 - "Thrombolytic therapy has been proven to be beneficial in selected patients with ischaemic strokes. " 12/01/2021 - "Thrombolytic therapy has been shown to be beneficial in acute ischemic stroke. "
4.	Stents 06/01/2021 - "The aim of this study was to evaluate the safety and efficacy of a manually expandable stent retriever (Tigertriever, Rapid Medical, Yoqneam, Israel) in the treatment of acute ischemic stroke caused by intracranial large vessel occlusions (LVO). " 09/01/2020 - "The prospective, multicenter Revive Acute ischemic stroke Patients ImmeDiately (RAPID) trial was carried out to evaluate the real-world safety and efficacy of the Revive SE stent retriever. " 08/01/2022 - "To evaluate the safety and efficacy of the Tigertriever 13 (Rapid Medical, Yoqneam, Israel) stent retriever in acute ischemic stroke (AIS) patients with primary or secondary distal, medium vessel occlusions (DMVO). " 12/01/2016 - "This meta-analysis showed that among patients undergoing coronary stent implantation, requiring chronic OAC, the use of a TT is associated with a significant reduction in overall mortality, recurrent MI and ischemic stroke. " 08/01/2016 - "Acute ischemic stroke in a child due to basilar artery occlusion treated successfully with a stent retriever."
5.	Secondary Prevention 06/01/2011 - "Percutaneous PFO closure appears to be effective for secondary prevention of cryptogenic stroke in younger patients but seems to be related with less beneficial outcome in elderly. " 10/01/2021 - "Recent trials have shown that transcatheter PFO closure is superior to medical treatment in the secondary prevention of ischaemic stroke. " 04/11/2006 - "Low dosed ASA can be considered cost-effective in secondary prevention of ischemic stroke, which is not the case for clopridogrel. " 01/01/2018 - "It appears that device closure as secondary prevention measure is an effective and safe procedure reducing the recurrence of neurological events in cryptogenic stroke patients <60 years with large PFOs. " 08/01/2021 - "Therefore, this study aimed to evaluate the safety and efficacy of a novel OAC initiation protocol for secondary prevention of acute ischemic stroke associated with AF. "