¡Es el Astrocito, Estúpido! Es la Recanalización, para Socorrer al Astrocito y Salvar la Neurona
DOI:
https://doi.org/10.56116/cms.v63.n4.2023.1760Palabras clave:
Isquemia Cerebral, Trombectomía, Astrocito, Sistema GlinfáticoResumen
Los últimos ensayos clínicos de pacientes con ataque cerebrovascular sometidos a trombectomía mecánica v/s mejor tratamiento médico, mostraron resultados favorables incluso en pacientes con un “core” isquémico extenso. En un metaanálisis reciente se mostró que incluso era beneficioso para pacientes con una isquemia extensa y hasta 24 hrs desde la última vez visto bien (Saraj, 2023). En este artículo revisamos distintos ensayos clínicos que evalúan la trombectomía, la fisiopatología de la isquemia y proponemos al astrocito y el sistema glinfático, como foco principal en los efectos del tratamiento. Planteamos la necesidad de cambiar el paradigma del tratamiento actual en pacientes con “core” isquémico extenso, a su vez la necesidad de considerar estos cambios en el financiamiento y la organización de una red nacional de trombectomía por parte de las autoridades gubernamentales.
Descargas
Citas
Astrup J, Symon L, Branston NM, Lassen NA. (1977). Cortical evoked potential and extracellular K+ and H+ at critical levels of brain ischemia. Stroke. 8:51–7. doi:10.1161/01.STR.8.1.51
Barkho, B. Z., Song, H., Aimone, J. B., Smrt, R. D., Kuwabara, T., Nakashima, K., et al. (2006). Identification of astrocyte-expressed factors that modulate neural stem/progenitor cell differentiation. Stem cells and development, 15(3), 407–421. https://doi.org/10.1089/scd.2006.15.407
Bendszus, M., Fiehler, J., Subtil, F., Bonekamp, S., Aamodt, A. H., Fuentes, B., et al. (2023). Endovascular thrombectomy for acute ischaemic stroke with establi- shed large infarct: multicentre, open-label, randomised trial. Lancet (London, England), S0140-6736(23)02032-9.
Blackband, S. J., Flint, J. J., Hansen, B., Shepherd, T. M., Lee, C. H., Streit, W. J., & Forder, J. R. (2020). On the Origins of Diffusion MRI Signal Changes in Stroke. Frontiers in neurology, 11, 549. https://doi.org/10.3389/fneur.2020.00549
Branston NM, Strong AJ, Symon L. (1977). Extracellular potassium activity, evoked potential and tissue blood flow. Relationships during progressive ischaemia in baboon cerebral cortex. J Neurol Sci. 32:305–21. doi:10.1016/0022-510X(77)90014-4
Chalet, L., Boutelier, T., Christen, T., Raguenes, D., Debatisse, J., Eker, O. F., et al. (2022). Clinical Imaging of the Penumbra in Ischemic Stroke: From the Concept to the Era of Mechanical Thrombectomy. Frontiers in cardiovascular medicine, 9, 861913. https://doi.org/10.3389/fcvm.2022.861913
Campbell, B. C. V., Mitchell, P. J., Churilov, L., Yassi, N., Kleinig, T. J., Dowling, R. J., Yan, B., et al. (2018). Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke. The New England journal of medicine, 378(17), 1573–1582. https://doi.org/10.1056/NEJMoa1716405
Costalat, V., Lapergue, B., Albucher, J. F., Labreuche, J., Henon, H., Gory, B., et al. (2023). Evaluation of acute mechanical revascularization in large stroke (ASPECTS ≤5) and large vessel occlusion within 7h of last-seen-well: The LASTE multicenter, randomized, clinical trial protocol. International journal of stroke: official journal of the International Stroke Society, 17474930231191033. Advance online publication.
Cox Vial, P., Tomasello Weitz, A., & Bravo Castro, E. (2023). Trombectomía Ya!. Cuadernos Médico Sociales, 63(1), 33– 36. https://doi.org/10.56116/cms.v63.n1.2023.1083
Daneman, R., & Prat, A. (2015). The blood-brain barrier. Cold Spring Harbor pers- pectives in biology, 7(1), a020412. https://doi.org/10.1101/cshperspect.a020412
Fisher, M., & Savitz, S. I. (2022). Pharmacological brain cytoprotection in acute ischaemic stroke-renewed hope in the reperfusion era. Nature reviews. Neurology, 18(4), 193–202. https://doi.org/10.1038/s4158202100605-6
Flint, J. J., Hansen, B., Portnoy, S., Lee, C. H., King, M. A., Fey, M., et al (2012). Magnetic resonance microscopy of human and porcine neurons and cellular processes. NeuroImage, 60(2), 1404–1411. https://doi.org/10.1016/j.neuroimage.2012.01.050
Gaberel, T., Gakuba, C., Goulay, R., Martinez De Lizarrondo, S., Hanouz, J. L., et al. (2014). Impaired glymphatic perfusion after strokes revealed by contrast-enhanced MRI: a new target for fibrinolysis?. Stroke, 45(10), 3092–3096. https://doi.org/10.1161/STROKEAHA.114.006617
Gallardo, A., & Cox, P. (2023). Actualización en el Manejo Agudo del Ataque Cerebrovascular Isquémico. Ictus, 4(2), e31072304007. https://doi.org/10.5281/zenodo.8403633
Goyal, M., Menon, B. K., van Zwam, W. H., Dippel, D. W., Mitchell, P. J., Demchuk, A. M., et al. (2016). Endovascular thrombec- tomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet (London, England), 387 (10029),1723–1731. https://doi.org/10.1016/S01406736(16)00163-X
Goyal, M., Ospel, J. M., Menon, B., Almekhlafi, M., Jayaraman, M., Fiehler, J., et al. (2020). Challenging the Ischemic Core Concept in Acute Ischemic Stroke Imaging. Stroke, 51(10), 3147–3155. https://doi.org/10.1161/STROKEAHA.120.030620
Harder, D. R., Zhang, C., & Gebremedhin, D. (2002). Astrocytes function in matching blood flow to metabolic activity. News in physiological sciences : an international journal of physiology produced jointly by the International Union of Physiological Sciences and the American Physiological Society, 17, 27–31. https://doi.org/10.1152/physiologyonline.2002.17.1.27
Hill, M. D., Goyal, M., Menon, B. K., Nogueira, R. G., McTaggart, R. A., Demchuk, A. M., et al. (2020). Efficacy and safety of nerinetide for the treatment of acute ischaemic stroke (ESCAPE- NA1): a multicentre, double-blind, rando- mised controlled trial. Lancet (London, England), 395(10227), 878–887. https://doi.org/10.1016/S0140-6736(20)30258-0
Holland E. (2023). This revolutionary stroke treatment will save millions of lives. Eventually. The New York Times. March 1, 2023. Updated March 22, 2023. https://www.nytimes.com/2023/03/01/magazine/evt-stroke-treatment.html
Iadecola C. (2017). The Neurovascular Unit Coming of Age: A Journey through Neurovascular Coupling in Health and Disease. Neuron, 96(1), 17–42. https://doi.org/10.1016/j.neuron.2017.07.030
Jovin, T. G., Nogueira, R. G., Lansberg, M. G., Demchuk, A. M., Martins, S. O., Ribo, M., Albers, G. W. (2022). Thrombectomy for anterior circulation stroke beyond 6 h from time last known well (AURORA): a systematic review and individual patient data meta-analysis. Lancet (London, England), 399(10321), 249–258.
https://doi.org/10.1016/S0140-6736(21)01341-6
Kadry, H., Noorani, B. & Cucullo, L.A. (2020) blood–brain barrier overview on structure, function, impairment, and biomarkers of in- tegrity. Fluids Barriers CNS 17, 69. https://doi.org/10.1186/s12987-020-00230-3
Levenson T. (2016) The Hunt for Vulcan. Random House, New York, USA, ISBN978-0-8129-8830-7
Mattson M. P. (2008). Hormesis defined. Ageing research reviews, 7(1), 1–7. https://doi.org/10.1016/j.arr.2007.08.007
Mestre H, Du T, Sweeney AM, Liu G,Samson AJ, Peng W, Mortensen KN, et al. (2020). Cerebrospinal fluid influx drives acute ischemic tissue swelling. Science. 2020 Mar 13;367(6483):eaax7171. doi:10.1126/science.aax7171. Epub 2020 Jan 30. PMID: 32001524; PMCID: PMC7375109.
Muoio, V., Persson, P. B., & Sendeski, M. M. (2014). The neurovascular unit - concept review. Acta physiologica (Oxford, England), 210(4), 790–798. https://doi.org/10.1111/apha.12250
Navarrete, M., & Araque, A. (2011). Basal synaptic transmission: astrocytes rule!. Cell, 146(5), 675–677. https://doi.org/10.1016/j.cell.2011.08.006
Nedergaard, M., Ransom, B., & Goldman, S. A. (2003). New roles for astrocytes: redefi- ning the functional architecture of the brain. Trends in neurosciences, 26(10), 523–530. https://doi.org/10.1016/j.tins.2003.08.008
Nedergaard M. (2013). Neuroscience. Garbage truck of the brain. Science. 28; 340(6140):1529-30. doi:10.1126/science.1240514. PMID: 23812703; PMCID: PMC3749839.
Nguyen TN, Abdalkader M, Nagel S, Qureshi MM, Ribo M, Nogueira RG. (2022). Noncontrast Computed Tomography vs Computed Tomography Perfusion or Magnetic Resonance Imaging Selection in Late Presentation of Stroke With Large- Vessel Occlusion. JAMA Neurol. 1; 79(1):22- 31. doi:10.1001/jamaneurol.2021.4082. Erratum in: JAMA Neurol. 2022 Jan 1;79(1):93. PMID: 34747975; PMCID:PMC8576630.
Radford B., (2011) https://www.livescience.com/33452-how-kill-vampire.html
Ribeiro, M.deC., Hirt, L., Bogousslavsky, J., Regli, L., & Badaut, J. (2006). Time course of aquaporin expression after transient focal cerebral ischemia in mice. Journal of neuroscience research, 83(7), 1231–1240. https://doi.org/10.1002/jnr.20819
Sarraj A. (2023). MechAnical thrombectomy for larGe braiN infArctions. Presented at: ESOC 2023. Munich Germany.
Toh, C. H., & Siow, T. Y. (2021). Glymphatic Dysfunction in Patients With Ischemic Stroke. Frontiers in aging neuroscience, 13, 756249. https://doi.org/10.3389/fnagi.2021.756249
Walther, J., Kirsch, E. M., Hellwig, L., Schmerbeck, S. S., Holloway, P. M., Buchan, A. M., & Mergenthaler, P. (2023). Reinventing the Penumbra the Emerging Clockwork of a Multimodal Mechanistic Paradigm. Translational stroke research, 14(5), 643–666. https://doi.org/10.1007/s12975-022-01090-9
Wang, Y. J., Sun, Y. R., Pei, Y. H., Ma, H. W., Mu, Y. K., Qin, L. H., & Yan, J. H. (2023). The lymphatic drainage systems in the brain: a novel target for ischemic stroke?. Neural regeneration research, 18(3), 485–491. https://doi.org/10.4103/1673-5374.346484
Warach S, Dashe JF and Edelman RR. (1996). Clinical outcome in ischemic stroke predicted by early diffusion-weighted and perfusion magnetic resonance imaging: a preliminary analysis. J Cereb Blood Flow Metab 1996; 16: 53–59.
Descargas
Publicado
Cómo citar
Licencia
Derechos de autor 2024 Pablo Cox, Andrés Gallardo
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.
