Prevention and protection against cerebral ischemic injury using acupuncture.

Abstract

Cardiovascular disease is the leading cause of death worldwide. Stroke is the second leading cause of death above the age of 60 years and the leading cause of acquired disability in adults. The main type of stroke is ischemic stroke (80%) and it is subclassified as thrombotic or embolic in nature. A thrombotic stroke or infarction occurs when a clot forms in an artery supplying the brain and accounts for approximately 50% of all strokes, whereas an embolic stroke is the result of a clot formed elsewhere in the body which was subsequently transported through the bloodstream to the brain. The only FDA-approved intervention for ischemic strokes is intravenous administration of tissue plasminogen activator (tPA), which acts by dissolving the blood clot (or recanalization) within 4.5 hours of stroke onset and thereby, improving blood flow to the part of the brain being deprived of blood. Transcranial laser therapy (TLT), administered close to the time of stroke onset, initially showed promising results in ischemic stroke patients but the most recent large scale, multi-center clinical trial NEST-3 was terminated after a futility analysis showed no difference between TLT and sham treatment in the primary endpoint which was disability at 90 days. Critical factors for TLT are the amount of energy that would penetrate the skull and be received by deeper structures in the brain, and the time interval between stroke onset and the initiation of treatment.