MD Conference Express ISC 2012 - (Page 8)
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F E A T U R E
From Neurovascular Laboratory to Clinic: A Journey Through Time
Written by Rita Buckley
Approximately 795,000 people experience a new or recurrent stroke each year. Mortality data from 2008 indicate that stroke accounted for about 1 of every 18 deaths in the United States (US). On average, someone in the US has a stroke every 40 seconds [Veronique LR et al. Circulation 2012]. Gregory J. del Zoppo, MD, MS, FAHA, University of Washington, Seattle, Washington, USA, discussed changes in how we understand brain microvessel structure, neuron-vascular interactions, and the translation of scientific findings into clinical care in The Thomas Willis Lecture, entitled “Toward the ‘Neurovascular Unit:’ A Journey in Clinical Translation.” In the mid- to late-1970s, the therapeutic attitude toward stroke patients was nihilistic, with few specific treatment approaches, CT scanning in its early days, and little data on the risks and benefits of antithrombotic approaches. Fibrinolysis was contraindicated, and cerebral blood vessels were considered inert conduits. Since then, experimental and clinical data have increased our comprehension of the molecular processes that cause ischemic damage to neurons and glia, the simultaneous mechanisms that underlie the maturation of the ischemic lesion to infarction, and the acute responses of microvessels in the ischemic territory. However, there is a need to understand these processes [del Zoppo GJ. J Intern Med 2010] as a single neurovascular unit (ie, to link microvessel with neuron [neuron-vascular] interactions) [del Zoppo GJ. J Intern Med 2010]. Dr. del Zoppo’s presentation detailed the work over 3 decades that has defined the impact of ischemia during stroke on microvessel function and responses in the context of neuronal damage. The Neurovascular Unit The “neurovascular unit” consists of microvessels, astrocytes, neurons and their axons, and other supporting cells that are likely to modulate the function of the “unit” [del Zoppo GJ. Ann NY Acad Sci 2010]. It is a conceptual framework that links microvessel and neuron function and their responses to injury. It is also a structural arrangement that links microvessel components with neurons via common astrocytes. Peer-Reviewed Highlights from the In the central nervous system, microvessel-neuron interactions appear to be highly coordinated. In experimental ischemic stroke, the rapid simultaneous reactions of the microvasculature, neurons, and glia to focal ischemia suggest that these responses could be viewed in a unitary fashion rather than as individual components [del Zoppo GJ. Ann NY Acad Sci 2010]. Neurovascular coupling enables neurons to modulate cerebral blood flow in regions of activation. Although little is known about the microvessel-to-neuron direction of the relationship, data support a unitary hypothesis in which microvessel and neuron responses are related, with implications for signaling events, potential treatment targets, and clinical outcomes. The Journey to the Neurovascular Unit Dr. del Zoppo discussed a wide range of new findings that have been studied en route to the notion of the neurovascular unit. These include the variety and rapidity of intravascular events following ischemic stroke, in particular endothelial cell responses to ischemia, the focal “no-reflow” phenomenon and its relation to polymorphonuclear (PMN) leukocyte adhesion, fibrin formation, platelet activation, and tissue factor expression (Table 1);
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Table of Contents for the Digital Edition of MD Conference Express ISC 2012
MD Conference Express ISC 2012
From Neurovascular Laboratory to Clinic: A Journey Through Time
No Compelling Evidence to Use Warfarin or Aspirin in Heart Failure Patients
AXIS 2 Clinical Outcomes No Different Than Placebo
SAMMPRIS: 30-Day Outcomes After Angioplasty and Stenting
Aggressive Medical Therapy Benefits Those Who Fail Antithrombotic Therapy
Initial Clinical Results with TREVO® Mechanical Thrombectomy Device are Promising
Linking sICH Definitions to Outcomes
Solitaire™ Flow Restoration Device Achieves Successful Recanalization Free of Symptomatic Hemorrhage Transformation
FIA II Seeks Genetic Underpinnings of Familial Intracranial Aneurysm
SPS3 Study Does Not Support the Use of Combination Therapy for Stroke Prevention
Novel Agent NA-1 Proves that Ischemic Neuroprotection is Possible in Older Patients
Acute Endovascular Treatment
Neuroimaging
Stroke Guidelines: Current Recommendations in Principle and Practice
The Rising Trend of Ischemic Stroke in the Young
Advanced Neuroimaging Adds Time, Reduces Endovascular Treatment in Clinical Practice
MD Conference Express ISC 2012
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