Intra-Arterial Delivery of Cell Therapies for Stroke.
Intra-Arterial Delivery of Cell Therapies for Stroke.
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DOI：
10.1161/strokeaha.117.018288
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发表时间：
2018-05
期刊：
影响因子：
8.3
通讯作者：
Walczak P
中科院分区：
文献类型：
--
作者：
Guzman R;Janowski M;Walczak P
2中风2018年5月，维持毛细血管的营养功能。虽然可以容忍某种程度的暂时性毛细血管阻塞，但如果超过临界阈值，则不可避免地导致局部缺氧/缺血和微栓塞病变。不同脑结构的大脑毛细血管密度不同，皮层的密度约为胼胝体的5倍，在这种情况下，白质可能更容易受到毛细血管阻塞的影响。在动脉内干细胞输送过程中，相对大量的细胞被注入，预期它们会被脑血管系统捕获；然而，电池负载或局部压力干扰可能危及该过程的安全性。迄今为止，已经发表了50多篇卒中动脉内细胞递送研究，许多研究报告了手术相关的并发症。在安全性方面吸取了重要的教训，并确定了几个对动脉内细胞输送安全性至关重要的因素。确定的最重要的变量是细胞类型和大小、细胞剂量、输注速度和输注期间喂养血管中动脉血流的保存。其他需要考虑的重要因素是中风发作后的时间和靶的解剖学考虑（图1）。实验条件的全面概述包含在仅在线数据补充的表1中。有关安全的详细信息包含在仅在线数据补充的表II中。
2 Stroke May 2018 so the trophic function of capillaries is maintained. Although some degree of temporary capillary blockage may be tolerated, if a critical threshold is exceeded, this inevitably leads to local hypoxia/ischemia and microembolic lesions. The density of cerebral capillaries varies in different brain structures, with the cortex having≈ 5× the density of the corpus callosum, 11 and in this context, white matter might be more vulnerable to capillary occlusion. During intra-arterial stem cell delivery, relatively large numbers of cells are infused, with the anticipation that they will be captured by the cerebral vasculature; however, the cell load or local pressure disturbances may compromise the safety of this procedure. To date, over 50 intra-arterial cell delivery studies in stroke have been published, and many studies have reported procedure-related complications. Important lessons on safety were learned, and several factors have been identified as critical for the safety of intra-arterial cell delivery. The most important variables that were identified are cell type and size, cell dose, infusion speed, and preservation of arterial blood flow in the feeding vessel during infusion. Other important factors to consider are timing after stroke onset and the anatomic considerations of the target (Figure 1). Comprehensive overview of the experimental conditions is included in Table I in the onlineonly Data Supplement. Details pertaining safety are included in Table II in the online-only Data Supplement.