Reperfusion stroke injury and brain atrophy: a penumbra of progressive cognitive decline

 You described a problem; provided NO solution! How the hell do you still have a job in stroke?

Reperfusion stroke injury and brain atrophy: a penumbra of progressive cognitive decline

Chavda, Vishal MS, PhD^a; Tunde Ayomide, Olobatoke MD^b; Stary, Creed M MD, PhD^c; Chaurasia, Bipin MS^d,*

Author Information

Annals of Medicine & Surgery ():10.1097/MS9.0000000000003735, August 19, 2025. | DOI: 10.1097/MS9.0000000000003735

• Open
• PAP

Abstract

Reperfusion therapy has revolutionized ischemic stroke management, yet its potential to induce secondary reperfusion brain injury (RBI) has emerged as a critical concern. This editorial explores the mechanistic links between RBI, subsequent brain atrophy, and progressive cognitive decline. Inflammation, oxidative stress, astrocytic activation, and disruption of the neurovascular unit are implicated in this pathological continuum. Drawing from current literature, we discuss the potential role of astrocytosis in amyloid-β dynamics and highlight the urgent need for biomarkers(Biomarkers don't get you recovered! ARE YOU THAT BLITHERINGLY STUPID?) and neuroprotective strategies that extend beyond acute care(NOT RECOVERY!). Understanding these interconnections may reshape long-term stroke management and guide future research toward mitigating post-stroke neurodegeneration.

Association between time to treatment with endovascular reperfusion therapy and outcomes in patients with acute ischemic stroke treated in clinical practice

Your doctor can explain this and why no discussion of the failure to get patients fully recovered and what they are doing to correct that miserable failure. 

Association between time to treatment with endovascular reperfusion therapy and outcomes in patients with acute ischemic stroke treated in clinical practice

JAMA — Jahan R, et al. | July 18, 2019

Via a retrospective cohort study of 6,756 subjects with acute ischemic stroke (AIS) from January 2015 to December 2016 in a US nationwide clinical registry, researchers described the correlation of speed of treatment with results among patients with AIS who underwent endovascular-reperfusion therapy. Adverse events were symptomatic intracranial hemorrhage (sICH) and in-hospital mortality/hospice discharge in 6.7% and in 19.6% of patients, respectively. At discharge, 36.9% and 23.0% were ambulated independently and had functional independence, respectively.(So, pretty much a complete failure.) Between 30 to 270 minutes vs 271 to 480 minutes, time-outcome relations were nonlinear with steeper slopes in the onset-to-puncture adjusted analysis. Faster onset to puncture in 15-minute increments in the 30- to 270-minute time frame correlated with a greater likelihood of obtaining independent ambulation at discharge, lower in-hospital mortality/hospice discharge, and lower risk of sICH. Including in the 30- to the 120-minute window, a higher likelihood of discharge to home and lower in-hospital mortality/hospice discharge was seen with faster door-to-puncture times for each 15-minute increment. Shorter time to endovascular-reperfusion therapy was significantly correlated with better outcomes(NOT 100% RECOVERY) in cases with AIS due to large vessel occlusion treated in routine clinical practice.

Read the full article on JAMA