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Strategies to improve recovery in acute ischemic stroke patients: Iberoamerican Stroke Group Consensus

Authors

  • M Alonso de Leciñana,

    1. Stroke Unit, Deparment of Neurology, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
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  • M Gutiérrez-Fernández,

    1. Neuroscience and Cerebrovascular Research Laboratory, La Paz University Hospital, Neuroscience Area of IdiPAZ (Health Research Institute), Autónoma University of Madrid, Madrid, Spain
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  • M Romano,

    1. Department of Neurosciences, Center for Medical Education and Clinical Research Norberto Quirno, CEMIC, Buenos Aires, Argentina
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  • C Cantú-Brito,

    1. Department of Neurology, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
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  • A Arauz,

    1. Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, México City, DF, México
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  • LE Olmos,

    1. Department of Rehabilitation Medicine, FLENI Institute, Escobar, Argentina
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  • SF Ameriso,

    1. Department of Neurology, Institute for Neurological Research, FLENI, Buenos Aires, Argentina
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  • E Díez-Tejedor,

    Coordinator, Corresponding author
    1. Neuroscience and Cerebrovascular Research Laboratory, La Paz University Hospital, Neuroscience Area of IdiPAZ (Health Research Institute), Autónoma University of Madrid, Madrid, Spain
    2. Department of Neurology and Stroke Centre, La Paz University Hospital, Neuroscience Area of IdiPAZ (Health Research Institute), Autónoma University of Madrid, Madrid, Spain
    • Correspondence: Exuperio Díez-Tejedor, Department of Neurology and Stroke Centre, La Paz University Hospital, IdiPAZ Health Research Institute, Universidad Autónoma de Madrid, Paseo de la Castellana 261, 28046 Madrid, Spain.

      E-mail: exuperio.diez@salud.madrid.org

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  • and on behalf of Iberoamerican Stroke Group

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    • With the support of Iberoamerican Cerebrovascular Diseases Society.

  • Conflicts of interest: The authors declare no potential conflict of interest.
  • Disclosures: Different members have received consultant fees and/or travel stipends from and have collaborated as speakers or researchers with the following companies: Astra-Zeneca, Bayer, Bristol- Myers Squibb, Boehringer Ingelheim, Cellerix, Ferrer Grupo, Brainsgate, Merck/ MSD, Raffo, Pfizer, Sanofi, Sygnis Pharma AG, and EVER Neuro Pharma.

Abstract

Stroke is not only a leading cause of death worldwide but also a main cause of disability. In developing countries, its burden is increasing as a consequence of a higher life expectancy. Whereas stroke mortality has decreased in developed countries, in Latin America, stroke mortality rates continue to rise as well as its socioeconomic dramatic consequences. Therefore, it is necessary to implement stroke care and surveillance programs to better describe the epidemiology of stroke in these countries in order to improve therapeutic strategies. Advances in the understanding of the pathogenic processes of brain ischemia have resulted in development of effective therapies during the acute phase. These include reperfusion therapies (both intravenous thrombolysis and interventional endovascular approaches) and treatment in stroke units that, through application of management protocols directed to maintain homeostasis and avoid complications, helps to exert effective brain protection that decreases further cerebral damage. Some drugs may enhance protection, and besides, there is increasing knowledge about brain plasticity and repair mechanisms that take place for longer periods beyond the acute phase. These mechanisms are responsible for recovery in certain patients and are the focus of basic and clinical research at present. This paper discusses recovery strategies that have demonstrated clinical effect, or that are promising and need further study. This rapidly evolving field needs to be carefully and critically evaluated so that investment in patient care is grounded on well-proven strategies.

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