Perioperative stroke: A perspective on challenges and opportunities for experimental treatment and diagnostic strategies. (27th February 2022)

• Record Type: Journal Article
• Authors: Jin, Xia; Li, Peiying; Michalski, Dominik; Li, Shen; Zhang, Yueman; Jolkkonen, Jukka; Cui, Lili; Didwischus, Nadine; Xuan, Wei; Boltze, Johannes
• Other Names: Li Peiying guestEditor.; Yu Weifeng guestEditor.
• Is Part Of: CNS neuroscience & therapeutics. Volume 28:Number 4(2022)
• Page Start: 497
• Page End: 509
• Publication Date: 2022-02-27
• Subjects: experimental treatment -- neuroprotection -- perioperative stroke -- stroke -- translational research; Neuropharmacology -- Periodicals; Central nervous system -- Diseases -- Effect of drugs on -- Periodicals; 612.8
• DOI: 10.1111/cns.13816
• Languages: English
• ISSNs: 1755-5930

Abstract

Abstract: Perioperative stroke is an ischemic or hemorrhagic cerebral event during or up to 30 days after surgery. It is a feared condition due to a relatively high incidence, difficulties in timely detection, and unfavorable outcome compared to spontaneously occurring stroke. Recent preclinical data suggest that specific pathophysiological mechanisms such as aggravated neuroinflammation contribute to the detrimental impact of perioperative stroke. Conventional treatment options are limited in the perioperative setting due to difficult diagnosis and medications affecting coagulation in may cases. On the contrary, the chance to anticipate cerebrovascular events at the time of surgery may pave the way for prevention strategies. This review provides an overview on perioperative stroke incidence, related problems, and underlying pathophysiological mechanisms. Based on this analysis, we assess experimental stroke treatments including neuroprotective approaches, cell therapies, and conditioning medicine strategies regarding their potential use in perioperative stroke. Interestingly, the specific aspects of perioperative stroke might enable a more effective application of experimental treatment strategies such as classical neuroprotection whereas others including cell therapies may be of limited use. We also discuss experimental diagnostic options for perioperative stroke augmenting classical clinical and imaging stroke diagnosis. While some experimental stroke treatments may have specific advantages in perioperative stroke, the paucity of established guidelines or multicenter clinical research initiatives currently limits their thorough investigation. Abstract : Perioperative stroke is a feared condition due to difficulties in timely detection and overall worse outcome compared to spontaneously stroke. Experimental treatment strategies may provide specific benefits when targeting perioperative stroke and have been assessed regarding their applicability and feasibility in perioperative stroke.