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The ischemic penumbra is the region of the brain surrounding the ischemic core that receives limited blood supply via collateral circulation. When the occluded artery is not recanalized, the penumbra and the consequent neurological deficit worsen with time. Early recanalization after intravenous thrombolysis with tissue-type plasminogen activator (tPA; alteplase) improves dependence-free survival in patients with ischemic stroke. However, tPA is effective primarily in patients presenting without major arterial occlusion. Arterial recanalization and subsequent reperfusion with a stent retriever concomitant with the use of tPA greatly improve clinical outcomes even in those with large artery occlusion. Several randomized controlled trials have established the advantages of intra-arterial treatment in patients with acute ischemic stroke showing anterior large vessel occlusion, and these principles have been incorporated into clinical practice. However, some patients continue to show poor outcomes even after successful recanalization, which may be secondary to reperfusion injury. Inducing selective brain hypothermia by transarterial cooling may offer effective neuroprotection and could serve as a prospective/potential treatment strategy worth exploring for the management of reperfusion injury. (日本医科大学医学会雑誌 2018; 14: 81―89)

Development of Reperfusion Therapies and Exploration of Prospective Treatment Strategies beyond this Modality to Manage Acute Ischemic Stroke