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Stroke Management Advances and Potential New Treatments.

Michael Brainin

Stroke treatment aims for immediate reperfusion of the ischemic brain, and research is ongoing to find a medicine that might induce artery recanalisation more fully and with fewer side effects. The important studies that have verified the use and safety are covered in this review article. Other thrombolytic and anticoagulant medicines such as tenecteplase, desmoteplase, accord, tirofiban, abciximab, eptifibatide, and argatroban are also evaluated for safety and efficacy. Tenecteplase and desmoteplase are plasminogen activators that have a stronger affinity for fibrin and a longer half-life than alteplase. In preliminary trials, they demonstrated higher reperfusion rates and improved functional outcomes. Argatroban is a direct thrombin inhibitor that is used as an adjuvant to intravenous TPA and demonstrated greater rates of full recanalisation in the ARTTS research, with additional studies presently underway. Adjuvant thrombolysis procedures utilising transcranial ultrasound are also being researched, and have shown greater rates of full recanalization, as seen in the CLOTBUST study. Overall, medicinal therapy for stroke are significant because they are easier to administer than endovascular procedures, and novel medicines such as tenecteplase, desmoteplase, and adjuvant son thrombolysis are showing promising effects and await larger-scale clinical trials.

Stroke is the world’s second greatest cause of death and the third major cause of disabilityadjusted life years (DALYs). Over the last two decades, the absolute number of persons who experience a stroke each year, the number of stroke survivors, and the worldwide burden of stroke have all increased. This was due to increased life expectancy and lower mortality in the acute period of stroke care. The “pandemic” of stroke survivors should be taken seriously by public health systems and scientific communities. On the other hand, the increasing prevalence of patients affected by stroke sequelae necessitates a significant investment in economic resources for stroke rehabilitation. It turns this ethical obligation into an atomistic purpose. There is a need to increase rehabilitation while also lowering its costs. New neurorehabilitation technology can provide new tools for enhancing efficiency. Despite the great potential of these novel techniques, much effort needs to be done to integrate them into everyday rehabilitation programmes. These devices should be viewed as instruments in the hands of neurorehabilitation teams, to be used within the context of a rehabilitative programme, rather than being rehabilitative in and of themselves. They should, in fact, be incorporated into a complex model in which the goal and actual patient conditions coincide to design training with multimodal conditions mixing classical and well-known conventional therapy with novel approaches, including new technological gadgets.