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Stroke is the main cause of death and disability among Chinese, and neurorestoration is an effective therapeutic strategy for patients with stroke. In recent years, many achievements have been made in stroke neurorestoration, but viewpoints for managing stroke vary per discipline. In order to promote standardization of diagnosis and treatment for stroke neurorestoration, the Chinese Association of Neurorestoratology (CANR; Preparatory) and China Committee of International Association of Neurorestoratology (IANR-China Committee) organized professional experts in the field to integrate fragmented neurorestorative methods and establish clinical diagnostic and therapeutic guidelines for stroke neurorestoration. This guideline includes the diagnosis and staging of stroke and therapeutic recommendations for neurorestoration at different stages of stroke in order to improve survival and quality of life of stroke patients.


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Clinical diagnostic and therapeutic guidelines of stroke neurorestoration (2020 China version)

Show Author's information Xiaoling Guo1,( )Qun Xue2,( )Jianhua Zhao3Yi Yang4Yang Yu5Dezhong Liu6Jing Liu7Wenwu Yang8Linsen Mu9Ping Zhang10Tianyi Wang11Hongyan Han12Shoufeng Liu5Yuhua Zhu2Tao Wang14Chuanqiang Qu15Chuanqiang Qu15
Department of Neurology, 981 Hospital of PLA Joint Support Force, Chengde 067000, Hebei, China
Department of Neurology, First Affiliated Hospital of Suzhou University, Suzhou 215006, Jiangsu, China
Department of Neurology, First Affiliated Hospital of Xinxiang Medical University, Xinxiang 453100, Henan, China
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
Department of Rehabilitation Medicine, Tianjin Huanhu Hospital, Tianjin 300350, China
Department of Neurosurgery, Zhoukou Central Hospital, Zhoukou 466000, Henan, China
Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian 116021, Liaoning, China
Department of Neurosurgery, 981 Hospital of PLA Joint Support Force, Chengde 067000, Hebei, China
Department of Neurosurgery, Guangdong 999 Brain Hospital, Guangzhou 510510, Guangdong, China
Department of Neurology, Shenzhen University General Hospital, Shenzhen 518055, Guangdong, China
Department of Orthopedics, 981 Hospital of PLA Joint Support Force, Chengde 067000, Hebei, China
Department of Neurosurgery, Beijing Aviation General Hospital, Beijing 100020, China
Department of Neurological Rehabilitation, Tianjin Huanhu Hospital, Tianjin 300350, China
Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
Department of Neurology, Provincial Hospital Affiliated to Shandong First Medical University (Shandong Provincial Hospital), Jinan 250021, Shandong, China

Abstract

Stroke is the main cause of death and disability among Chinese, and neurorestoration is an effective therapeutic strategy for patients with stroke. In recent years, many achievements have been made in stroke neurorestoration, but viewpoints for managing stroke vary per discipline. In order to promote standardization of diagnosis and treatment for stroke neurorestoration, the Chinese Association of Neurorestoratology (CANR; Preparatory) and China Committee of International Association of Neurorestoratology (IANR-China Committee) organized professional experts in the field to integrate fragmented neurorestorative methods and establish clinical diagnostic and therapeutic guidelines for stroke neurorestoration. This guideline includes the diagnosis and staging of stroke and therapeutic recommendations for neurorestoration at different stages of stroke in order to improve survival and quality of life of stroke patients.

Keywords:

neurorestoration, clinical guideline, stroke
Received: 22 October 2020 Revised: 13 December 2020 Accepted: 28 December 2020 Published: 07 February 2021 Issue date: December 2020
References(67)
[1]
WZ Wang, B Jiang, HX Sun, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults. Circulation. 2017, 135(8): 759-771.
[2]
MG Zhou, HD Wang, XY Zeng, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019, 394(10204): 1145-1158.
[3]
HP Jr Adams, BH Bendixen, LJ Kappelle, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993, 24(1): 35-41.
[4]
R Ornello, D Degan, C Tiseo, et al. Distribution and temporal trends from 1993 to 2015 of ischemic stroke subtypes: a systematic review and meta-analysis. Stroke. 2018, 49(4): 814-819.
[5]
H Huang, G Raisman, PR Sanberg, et al. Neurorestoratology. New York: Nova Biomedical, 2015.
[6]
LH Bonati, J Dobson, RL Featherstone, et al. Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial. Lancet. 2015, 385(9967): 529-538.
[7]
GW Albers, MP Marks, S Kemp, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018, 378(8): 708-718.
[8]
RG Nogueira, AP Jadhav, DC Haussen, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018, 378(1): 11-21.
[9]
WN Kernan, B Ovbiagele, HR Black, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014, 45(7): 2160-2236.
[10]
WS Moore, RF Kempczinski, JJ Nelson, et al. Recurrent carotid stenosis: results of the asymptomatic carotid atherosclerosis study. Stroke. 1998, 29(10): 2018-2025.
[11]
CD Liapis, PR Bell, D Mikhailidis, et al. ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques. Eur J Vasc Endovasc Surg. 2009, 37(4 Suppl): 1-19.
[12]
TG Brott, G Howard, GS Roubin, et al. Long-term results of stenting versus endarterectomy for carotid-artery Stenosis. N Engl J Med. 2016, 374(11): 1021-1031.
[13]
TG Brott, D Calvet, G Howard, et al. Long-term outcomes of stenting and endarterectomy for symptomatic carotid stenosis: a preplanned pooled analysis of individual patient data. Lancet Neurol. 2019, 18(4): 348-356.
[14]
LH Bonati, J Gregson, J Dobson, et al. Restenosis and risk of stroke after stenting or endarterectomy for symptomatic carotid stenosis in the International Carotid Stenting Study (ICSS): secondary analysis of a randomised trial. Lancet Neurol. 2018, 17(7): 587-596.
[15]
Chinese Society of Neurology, Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018. Chin J Neurol. 2018, 51(9): 666-682.
[16]
WJ Powers, AA Rabinstein, T Ackerson, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke. 2019, 50(12): e344-e418.
[17]
FDA expands treatment window for use of clot retrieval devices in certain stroke patients. (accessed 1 Oct, 2020).
[18]
ML Mendonça, GR Freitas, SA Silva, et al. Safety of intra-arterial autologous bone marrow mononuclear cell transplantation for acute ischemic stroke. Arq Bras Cardiol. 2006, 86(1): 52-55.
[19]
SI Savitz, V Misra, M Kasam, et al. Intravenous autologous bone marrow mononuclear cells for ischemic stroke. Ann Neurol. 2011, 70(1): 59-69.
[20]
FS Vahidy, ME Haque, MH Rahbar, et al. Intravenous bone marrow mononuclear cells for acute ischemic stroke: safety, feasibility, and effect size from a phase I clinical trial. Stem Cells. 2019, 37(11): 1481-1491.
[21]
S Banerjee, P Bentley, M Hamady, et al. Intra-arterial immunoselected CD34+ stem cells for acute ischemic stroke. Stem Cells Transl Med. 2014, 3(11): 1322-1330.
[22]
DC Hess, LR Wechsler, WM Clark, et al. Safety and efficacy of multipotent adult progenitor cells in acute ischaemic stroke (MASTERS): a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Neurol. 2017, 16(5): 360-368.
[23]
R McCourt, B Gould, L Gioia, et al. Cerebral perfusion and blood pressure do not affect perihematoma edema growth in acute intracerebral hemorrhage. Stroke. 2014, 45(5): 1292-1298.
[24]
J Zheng, H Li, S Lin, et al. Perioperative antihypertensive treatment in patients with spontaneous intracerebral hemorrhage. Stroke. 2017, 48(1): 216-218.
[25]
JC 3rd Hemphill, SM Greenberg, CS Anderson, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American heart association/ American stroke association. Stroke. 2015, 46(7): 2032-2060.
[26]
BJ Kim, SU Kwon, JH Park, et al. Cilostazol versus aspirin in ischemic stroke patients with high-risk cerebral hemorrhage: subgroup analysis of the PICASSO trial. Stroke. 2020, 51(3): 931-937.
[27]
C You, H Li. Pay more attention to and standardize the surgical treatment of hypertensive cerebral hemorrhage. Chin J Neurosurg. 2011, 27(8): 757-758.
[28]
JY Wang, B Shao, , et al. Ideal cardiovascular health metrics associated with reductions in the risk of extracranial carotid artery stenosis: a population-based cohort study. Sci Rep. 2018, 8(1): 12277.
[29]
J Guay, S Kopp. Cerebral monitors versus regional anesthesia to detect cerebral ischemia in patients undergoing carotid endarterectomy: a meta-analysis. J Can D'anesthesie. 2013, 60(3): 266-279.
[30]
F Moniche, A Gonzalez, JR Gonzalez-Marcos, et al. Intra-arterial bone marrow mononuclear cells in ischemic stroke: a pilot clinical trial. Stroke. 2012, 43(8): 2242-2244.
[31]
V Bhatia, V Gupta, D Khurana, et al. Randomized assessment of the safety and efficacy of intra-arterial infusion of autologous stem cells in subacute ischemic stroke. AJNR Am J Neuroradiol. 2018, 39(5): 899-904.
[32]
K Prasad, S Mohanty, R Bhatia, et al. Autologous intravenous bone marrow mononuclear cell therapy for patients with subacute ischaemic stroke: a pilot study. Indian J Med Res. 2012, 136(2): 221-228.
[33]
A Taguchi, C Sakai, T Soma, et al. Intravenous autologous bone marrow mononuclear cell transplantation for stroke: Phase1/2a clinical trial in a homogeneous group of stroke patients. Stem Cells Dev. 2015, 24(19): 2207-2218.
[34]
OY Bang, JS Lee, PH Lee, et al. Autologous mesenchymal stem cell transplantation in stroke patients. Ann Neurol. 2005, 57(6): 874-882.
[35]
JS Lee, JM Hong, GJ Moon, et al. A long-term follow-up study of intravenous autologous mesenchymal stem cell transplantation in patients with ischemic stroke. Stem Cells. 2010, 28(6): 1099-1106.
[36]
J Fang, Y Guo, S Tan, et al. Autologous endothelial progenitor cells transplantation for acute ischemic stroke: a 4-year follow-up study. Stem Cells Transl Med. 2019, 8(1): 14-21.
[37]
K Prasad, A Sharma, A Garg, et al. Intravenous autologous bone marrow mononuclear stem cell therapy for ischemic stroke: a multicentric, randomized trial. Stroke. 2014, 45(12): 3618-3624.
[38]
V Battistella, GR de Freitas, LM da Fonseca, et al. Safety of autologous bone marrow mononuclear cell transplantation in patients with nonacute ischemic stroke. Regen Med. 2011, 6(1): 45-52.
[39]
AMA Hammadi, F Alhimyari. Intra-arterial injection of autologous bone marrow-derived mononuclear cells in ischemic stroke patients. Exp Clin Transplant. 2019, 17(Suppl 1): 239-241.
[40]
A Bhasin, M Srivastava, R Bhatia, et al. Autologous intravenous mononuclear stem cell therapy in chronic ischemic stroke. J Stem Cells Regen Med. 2012, 8(3): 181-189.
[41]
A Bhasin, MV Srivastava, S Mohanty, et al. Stem cell therapy: a clinical trial of stroke. Clin Neurol Neurosurg. 2013, 115(7): 1003-1008.
[42]
A Bhasin, MVP Srivastava, S Mohanty, et al. Paracrine mechanisms of intravenous bone marrow-derived mononuclear stem cells in chronic ischemic stroke. Cerebrovasc Dis Extra. 2016, 6(3): 107-119.
[43]
A Sharma, H Sane, N Gokulchandran, et al. Autologous bone marrow mononuclear cells intrathecal transplantation in chronic stroke. Stroke Res Treat. 2014, 2014: 234095.
[44]
ER Chernykh, EY Shevela, NM Starostina, et al. Safety and therapeutic potential of M2 macrophages in stroke treatment. Cell Transplant. 2016, 25(8): 1461-1471.
[45]
O Honmou, K Houkin, T Matsunaga, et al. Intravenous administration of auto serum-expanded autologous mesenchymal stem cells in stroke. Brain. 2011, 134(Pt 6): 1790-1807.
[46]
A Bhasin, MV Srivastava, SS Kumaran, et al. Autologous mesenchymal stem cells in chronic stroke. Cerebrovasc Dis Extra. 2011, 1(1): 93-104.
[47]
YJ Jiang, WS Zhu, JH Zhu, et al. Feasibility of delivering mesenchymal stem cells via catheter to the proximal end of the lesion artery in patients with stroke in the territory of the middle cerebral artery. Cell Transplant. 2013, 22(12): 2291-2298.
[48]
XL Guo, X Wang, Y Li, et al. Olfactory ensheathing cell transplantation improving cerebral infarction sequela: a case report and literature review. J Neurorestoratology. 2019, 7(2): 82-88.
[49]
KW Muir, D Bulters, M Willmot, et al. Intracerebral implantation of human neural stem cells and motor recovery after stroke: multicentre prospective single-arm study (PISCES-2). J Neurol Neurosurg Psychiatry. 2020, 91(4): 396-401.
[50]
GZ Zhang, Y Li, JL Reuss, et al. Stable intracerebral transplantation of neural stem cells for the treatment of paralysis due to ischemic stroke. Stem Cells Transl Med. 2019, 8(10): 999-1007.
[51]
SI Savitz, D Yavagal, G Rappard, et al. A phase 2 randomized, sham-controlled trial of internal carotid artery infusion of autologous bone marrow-derived ALD-401 cells in patients with recent stable ischemic stroke (RECOVER-stroke). Circulation. 2019, 139(2): 192-205.
[52]
YL Wang, XL Guo, J Liu, et al. Olfactory ensheathing cells in chronic ischemic stroke: A phase 2 double-blind, randomized, controlled trial. J Neurorestoratology. 2020, 8(3): 182-193.
[53]
A Sharma, H Sane, A Nagrajan, et al. Autologous bone marrow mononuclear cells in ischemic cerebrovascular accident paves way for neurorestoration: a case report. Case Rep Med. 2014, 2014: 530239.
[54]
KS Tsang, CPS Ng, XL Zhu, et al. Phase I/II randomized controlled trial of autologous bone marrow-derived mesenchymal stem cell therapy for chronic stroke. World J Stem Cells. 2017, 9(8): 133-143.
[55]
ML Levy, JR Crawford, N Dib, et al. Phase I/II study of safety and preliminary efficacy of intravenous allogeneic mesenchymal stem cells in chronic stroke. Stroke. 2019, 50(10): 2835-2841.
[56]
A Al Fauzi, P Sumorejo, NS Suroto, et al. Clinical outcomes of repeated intraventricular transplantation of autologous bone marrow mesenchymal stem cells in chronic haemorrhagic stroke. A one-year follow up. Open Neurol J. 2017, 11: 74-83.
[57]
LM Wang, HJ Ji, M Li, et al. Intrathecal administration of autologous CD34 positive cells in patients with past cerebral infarction: a safety study. ISRN Neurol. 2013, 2013: 128591.
[58]
DC Chen, SZ Lin, JR Fan, et al. Intracerebral implantation of autologous peripheral blood stem cells in stroke patients: a randomized phase II study. Cell Transplant. 2014, 23(12): 1599-1612.
[59]
PH Sung, HS Lin, WC Lin, et al. Intra-carotid arterial transfusion of autologous circulatory derived CD34+ cells for old ischemic stroke patients - a phase I clinical trial to evaluate safety and tolerability. Am J Transl Res. 2018, 10(9): 2975-2989.
[60]
GK Steinberg, D Kondziolka, LR Wechsler, et al. Clinical outcomes of transplanted modified bone marrow-derived mesenchymal stem cells in stroke: a phase 1/2a study. Stroke. 2016, 47(7): 1817-1824.
[61]
GK Steinberg, D Kondziolka, LR Wechsler, et al. Two-year safety and clinical outcomes in chronic ischemic stroke patients after implantation of modified bone marrow-derived mesenchymal stem cells (SB623): a phase 1/2a study. J Neurosurg. 2019, 131: 1462-1472.
[62]
D Kalladka, J Sinden, K Pollock, et al. Human neural stem cells in patients with chronic ischaemic stroke (PISCES): a phase 1, first-in-man study. Lancet. 2016, 388(10046): 787-796.
[63]
SS Rabinovich, VI Seledtsov, NV Banul, et al. Cell therapy of brain stroke. Bull Exp Biol Med. 2005, 139(1): 126-128.
[64]
L Chen, HT Xi, HY Huang, et al. Multiple cell transplantation based on an intraparenchymal approach for patients with chronic phase stroke. Cell Transplant. 2013, 22(Suppl 1): S83-S91.
[65]
LY Qiao, FJ Huang, MS Zhao, et al. A two-year follow-up study of cotransplantation with neural stem/progenitor cells and mesenchymal stromal cells in ischemic stroke patients. Cell Transplant. 2014, 23(Suppl 1): S65-S72.
[66]
D Kondziolka, GK Steinberg, L Wechsler, et al. Neurotransplantation for patients with subcortical motor stroke: a phase 2 randomized trial. J Neurosurg. 2005, 103(1): 38-45.
[67]
SanBio Co. Ltd. SanBio and Sumitomo Dainippon Pharma announce topline results from a phase 2b study in the U.S. evaluating SB623, a regenerative cell medicine for the treatment of patients with chronic stroke. (accessed 1 Oct, 2020).
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Received: 22 October 2020
Revised: 13 December 2020
Accepted: 28 December 2020
Published: 07 February 2021
Issue date: December 2020

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© The authors 2020

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This article is published with open access at http://jnr.tsinghuajournals.com

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