Adjunctive Therapies in Acute Ischemic Stroke: Beyond Thrombolysis and Thrombectomy

Acute ischemic stroke care has been transformed by intravenous thrombolysis and endovascular thrombectomy, which have substantially improved recanalization and functional outcomes. However, successful macrovascular recanalization does not always result in effective tissue reperfusion or neurological recovery. Tandem occlusions, intracranial atherosclerotic disease, incomplete reperfusion, acute reocclusion, distal embolization, and the need for rescue angioplasty or emergent stenting continue to present major therapeutic challenges. Important questions remain regarding how to optimize periprocedural antiplatelet treatment, manage no-reflow and microvascular dysfunction, reduce reperfusion injury, and safely integrate emerging therapies with established reperfusion techniques. Recent clinical, translational, and experimental studies have investigated agents such as aspirin, clopidogrel, tirofiban, and cangrelor, as well as adjunctive intra-arterial thrombolysis and neuroprotective strategies. Nevertheless, uncertainty persists regarding patient selection, treatment timing, dosing, routes of administration, safety, and the effects of these interventions on durable tissue reperfusion and functional recovery. Further investigation is needed to bridge the gap between angiographic success and meaningful clinical benefit.This Research Topic aims to examine current and emerging therapies that complement intravenous thrombolysis and endovascular thrombectomy in acute ischemic stroke. It will assess strategies for improving the efficacy and durability of reperfusion, preventing reocclusion, restoring microvascular flow, and limiting ischemic and reperfusion-related brain injury. The Research Topic will also explore the safety and effectiveness of periprocedural antiplatelet regimens and rescue interventions during endovascular treatment, including in patients requiring emergent stenting. In addition, it will consider how neuroprotective, pharmacological, biological, and other investigational therapies can be developed and evaluated alongside reperfusion treatment. By integrating clinical, translational, and experimental evidence, the Research Topic seeks to identify promising approaches and clarify priorities for future research.To gather further insights into adjunctive therapies used alongside intravenous thrombolysis and endovascular thrombectomy, this Research Topic will focus on acute ischemic stroke and will not replace established reperfusion treatments or address chronic stroke rehabilitation. We welcome articles addressing, but not limited to, the following themes:• Periprocedural antiplatelet strategies during endovascular treatment• Emergent extracranial and intracranial stenting, angioplasty, and rescue procedures• Adjunctive intra-arterial thrombolysis and rescue reperfusion strategies• Prevention and management of acute reocclusion and distal embolization• Microvascular reperfusion, tissue-level reperfusion, and the no-reflow phenomenon• Ischemia-reperfusion injury and endothelial or microcirculatory dysfunction• Neuroprotective therapies administered alongside reperfusion• Pharmacological and biological approaches targeting thrombosis, fibrinolysis, inflammation, or neuronal injury• Clinical trials, translational research, and experimental models of adjunctive therapy• Imaging, biomarkers, and outcome measures for evaluating tissue reperfusion and functional recovery Topic editors: Antonio De Mase, Emanuele Spina, Angelo Cascio Rizzo, Wenbo Zhao, Fabrizio Giammello Source: https://www.frontiersin.org/research-topics/85805/adjunctive-therapies-in-acute-ischemic-stroke-beyond-thrombolysis-and-thrombectomy