Molecular pathophysiological mechanisms of ischemia/reperfusion injuries after recanalization therapy for acute ischemic stroke

J Integr Neurosci. 2021 Sep 30;20(3):727-744. doi: 10.31083/j.jin2003078.

Abstract

With the larger variety of methods employed, recanalization therapy is increasingly used to treat acute ischemic stroke resulting in about one-third of patients undergoing early neurological deterioration, in which ischemia/reperfusion injuries are the main cause, leading to increases in the infarcted area, the no-reflow phenomenon, or hemorrhagic transformation. Efficient prevention or treatment of these injuries depends on extensive knowledge of the involved mechanisms. These pathways have dual, damaging, and neuroprotective effects, depending on the timing or protein subtype involved. The current article reviews the main mechanisms contributing to the pathophysiology of these injuries, such as mitochondrial dysfunction, cellular calcium overload, excitotoxicity, oxidative stress, apoptosis, and neuroinflammation.

Keywords: Apoptosis; Excitotoxicity; Mitochondria; Neuroinflammation; Oxidative stress; Reperfusion injury.

Publication types

  • Review

MeSH terms

  • Animals
  • Apoptosis* / physiology
  • Calcium* / metabolism
  • Humans
  • Ischemic Stroke / therapy*
  • Mitochondrial Diseases* / etiology
  • Mitochondrial Diseases* / metabolism
  • Neuroinflammatory Diseases* / etiology
  • Neuroinflammatory Diseases* / immunology
  • Neuroinflammatory Diseases* / metabolism
  • Oxidative Stress* / physiology
  • Reperfusion / adverse effects*
  • Reperfusion Injury* / etiology
  • Reperfusion Injury* / metabolism

Substances

  • Calcium