Magnesium sulfate in the management of acute ischemic stroke: A review of the literature and future directions.

IF 2 4区 医学 Q3 NEUROSCIENCES
Maximillian S Feygin, Alex Brenner, Omar Tanweer
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引用次数: 0

Abstract

Background: The management of acute ischemic stroke (AIS) was revolutionized within the last 15 years with the introduction of mechanical thrombectomy (MT) to standard of care. Despite the success of mechanical thrombectomy (MT) in achieving high recanalization rates for large vessel occlusion, functional independence post-treatment remains suboptimal. The current limitations of MT prompt evaluation of the role of adjunctive pharmacologic neuroprotective therapies to prevent excitotoxicity, cellular apoptosis, and inflammation that cause irreversible neuronal damage during AIS. Magnesium (MgSO4) provides an attractive neuroprotectant profile, having many different effects, and is inexpensive, readily available, and has a long-established safety and tolerability profile in the management of myocardial infarction and eclampsia.

Observations: This gap between technical success and patient outcomes is largely due to the inability to fully protect brain tissue from infarction during ischemia. MgSO4 has shown promise in preclinical studies for its neuroprotective properties, including blocking NMDA receptors, increasing cerebral blood flow, and stabilizing ion channels. However, clinical trials, such as FAST-MAG and IMAGES, failed to demonstrate significant benefits when MgSO4 was administered intravenously, due to delayed drug administration or delivery to target tissue. These trials highlighted the need for faster, more targeted drug delivery. Intra-arterial (IA) administration of MgSO4 via the catheter used in MT could address these limitations by delivering high doses directly to ischemic brain tissue, potentially enhancing neuroprotection while reducing systemic exposure. Preclinical studies and some clinical trials have demonstrated the safety and feasibility of IA, but not IA MgSO4. Further investigation is needed to assess its efficacy.

Conclusions: While past trials have not succeeded, IA administration of neuroprotective agents like MgSO4 may improve functional outcomes in stroke patients post-MT. Ongoing and future studies will determine if this approach can effectively complement reperfusion strategies, potentially ushering in a new era of stroke care.

硫酸镁在急性缺血性脑卒中治疗中的应用:文献综述与未来方向。
背景:在过去的 15 年里,随着机械性血栓切除术(MT)成为标准治疗方法,急性缺血性卒中(AIS)的治疗发生了革命性的变化。尽管机械性血栓切除术(MT)成功实现了大血管闭塞的高再通率,但治疗后的功能独立性仍不理想。目前机械取栓术的局限性促使人们对辅助药物神经保护疗法的作用进行评估,以防止兴奋毒性、细胞凋亡和炎症在 AIS 期间造成不可逆的神经元损伤。镁(MgSO4)是一种极具吸引力的神经保护剂,具有多种不同的作用,而且价格低廉、易于获得,在心肌梗死和子痫的治疗中具有长期公认的安全性和耐受性:观察结果:技术成功与患者预后之间的差距主要是由于无法在缺血期间充分保护脑组织免受梗死。临床前研究显示,硫酸镁具有神经保护特性,包括阻断 NMDA 受体、增加脑血流量和稳定离子通道。然而,FAST-MAG 和 IMAGES 等临床试验未能显示出静脉注射 MgSO4 的显著疗效,原因是给药或向靶组织给药延迟。这些试验强调了更快、更有针对性地给药的必要性。通过在 MT 中使用的导管进行动脉内 (IA) 给药可以解决这些局限性,将高剂量的 MgSO4 直接输送到缺血的脑组织,从而在减少全身暴露的同时加强神经保护。临床前研究和一些临床试验已经证明了 IA 的安全性和可行性,但还没有证明 IA MgSO4 的安全性和可行性。要评估其疗效,还需要进一步的研究:结论:虽然过去的试验并未取得成功,但在腔内注射 MgSO4 等神经保护剂可改善中风后 MT 患者的功能预后。正在进行的研究和未来的研究将确定这种方法是否能有效补充再灌注策略,从而开创卒中治疗的新时代。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.00
自引率
4.00%
发文量
583
审稿时长
62 days
期刊介绍: The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.
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