Stroke research lines

Despite medical advances, around 50% of patients with severe stroke remain disabled, so new treatments are needed to improve or add to the efficacy of revascularisation treatments. It is known that, despite restoring circulation in the main cerebral arteries, there are brain areas that do not recover a normal blood supply.

The CHOICE study, carried out in Catalonia thanks to funding from the TV3 Marathon, demonstrated that the administration of a fibrinolytic drug directly into the arteries of the brain after thrombus extraction is capable of minimising these residual circulatory deficits and increasing the chances of recovery for patients without sequelae. Using this new therapeutic strategy, the number of patients without sequelae after a stroke has increased by more than 19%. Currently it is working to confirm these results with a larger trial (CHOICE-2).

Regardless of the need to open the blocked artery after a stroke, the delivery of blood to an injured brain may enhance some brain injury mechanisms. For example, there are neuroprotective treatments, such as uric acid, which can prevent this harmful effect of revascularisation.

One clinical trial suggested that uric acid administration may be beneficial in stroke patients treated with intravenous thrombolysis, and the benefits may be greater in severe stroke patients treated with mechanical thrombectomy. This theory still has to be demonstrated in a new study before it can be recommended for more general use.

Repairing brain damage is a promising strategy for the post-stroke recovery phase; it extends beyond the initial treatment phase where the priority is to limit damage through the revascularisation of the obstructed artery.

Studies conducted in experimental models investigated the administration of stem cells to improve post-stroke recovery. Although the results are promising, the underlying mechanisms behind these improvements are still poorly understood. Some of these studies revealed most of the stem cells did not reach the brain, but were instead found in other organs such as the spleen where there are a large number of immune cells. This suggests that immunity modulation could explain some of the beneficial effects of stem cells.

Stem cell studies have been conducted in humans to assess the viability and safety of their administration, but treatment efficacy was not evaluated. There is still a lot of work to be done before stem cells can be used to treat strokes. It is important to determine the most suitable type of stem cell, method of administration and the moment after a stroke when their introduction would be most effective.