Prof. O.E. Dubenko 1, prof. O.A. Oparin 2, assoc. prof. L.A. Sysun 1
1 Kharkiv National Medical University,
2 Ukrainian Humanitarian Institute
The article presents modern views on the etiopathogenesis of ischemic stroke, data on research and methods of its treatment, and discusses the issue of endovascular and drug thrombolysis.
Preventive measures to reduce the risk of systemic complications in large stroke sizes are described. In addition to treatment tactics in the acute period of ischemic stroke, the paper shows the role of various methods of neurorehabilitation measures to restore motor activity of the limbs in patients who have suffered a stroke.
Key words: acute ischemic stroke, cerebral hemodynamics, etiopathogenesis of ischemic stroke, systolic blood pressure, cerebral vessels.
https://doi.org/10.15407/internalmed2026.01.013
Cite:
Дубенко, О.Є. Сучасне розуміння етіопатогенезу та менеджменту ішемічного інсульту / О.Є. Дубенко, О.А. Опарін, Л.А. Сисун // Східноєвропейський журнал внутрішньої та сімейної медицини. — 2026. — № 1. — С. 13-17. doi: 10.15407/internalmed2026.01.013
Dubenko OE, Oparin OA, Sysun LA. Suchasne rozuminnia etiopatohenezu ta menedzhmentu ishemichnoho insultu [Current understanding of etiopathogenesis and management of ischemic stroke]. Shidnoevr. z. vnutr. simejnoi med. 2026;1:13-17. Ukrainian. doi: 10.15407/internalmed2026.01.013
References:
1.Feigin VL, Brainin M, Norrving B, et al. World Stroke Organization: global stroke fact sheet 2025. Int J Stroke. 2025;20(2):132-44. https://doi.org/10.1177/17474930241308142
2.Gasull T, Arboix A. Molecular mechanisms and pathophysiology of acute stroke: emphasis on biomarkers in the different stroke subtypes. Int J Mol Sci. 2022;23(16):9476. https://doi.org/10.3390/ijms23169476
3.Mead GE, Sposato LA, Sampaio Silva G, et al. A systematic review and synthesis of global stroke guidelines on behalf of the World Stroke Organization. Int J Stroke. 2023;18(5):499-531. https://doi.org/10.1177/17474930231156753
4.Bathla G, Ajmera P, Mehta PM, et al. Advances in acute ischemic stroke treatment: current status and future directions. AJNR Am J Neuroradiol. 2023;44(7):750-8. https://doi.org/10.3174/ajnr.A7872
5.Berge, E.; Whiteley, W.; Audebert, H.; et al. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur. Stroke J. 2021, 6, I-LXII. https://doi.org/10.1177/2396987321989865
6.Turc, G.; Bhogal, P.; Fischer, U.; et al. European Stroke Organisation (ESO)-European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischaemic Stroke. Eur. Stroke J. 2019, 4, 6-12. https://doi.org/10.1177/2396987319832140
7.Dinsmore JE, Tan A. Anaesthesia for mechanical thrombectomy: a narrative review. Anaesthesia. 2022;77 (Suppl 1):59-68. https://doi.org/10.1111/anae.15586
8.Heran M, Lindsay P, Gubitz G, et al. Canadian stroke best practice recommendations: acute stroke management, 7th edition practice guidelines update, 2022. Can J Neurol Sci. 2024;51(1):1-31. https://doi.org/10.1017/cjn.2022.344
9.Maguida G, Shuaib A. Collateral circulation in ischemic stroke: an updated review. J Stroke. 2023;25(2):179-98. https://doi.org/10.5853/jos.2022.02936
10.Gonçalves OR, Ferreira MY, de Almeida Monteiro G, et al. Intravenous thrombolysis with tenecteplase versus alteplase in acute ischemic stroke tandem occlusions: a systematic review and meta-analysis of current available literature. J Thromb Thrombolysis. 2025;58(3):411-9. https://doi.org/10.1007/s11239-025-03084-4
11.Almanna MA, Aloraini ZS, Regenhardt RW, et al. Intravenous tenecteplase versus alteplase before mechanical thrombectomy in patients with large vessel occlusion stroke: a systematic review and meta-analysis. Cerebrovasc Dis. 2025;54(1):42-52. https://doi.org/10.1159/000536669
12.Yao B, Wang X, Wu Y, et al. Tenecteplase versus alteplase for intravenous thrombolysis of acute ischemic stroke patients with large-vessel occlusion: a systematic review and meta-analysis. Front Neurol. 2025;16:1487711. https://doi.org/10.3389/fneur.2025.1487711
13.Silva GS, Nogueira RG. Endovascular treatment of acute ischemic stroke. Continuum (Minneap Minn). 2020;26(2):310-31. https://doi.org/10.1212/CON.0000000000000852
14.Horvath LC, Bergmann F, Hossmann A, et al. Endovascular thrombectomy with or without intravenous thrombolysis in large-vessel ischemic stroke: a non-inferiority meta-analysis of 6 randomised controlled trials. Vascul Pharmacol. 2023;150:107177. https://doi.org/10.1016/j.vph.2023.107177
15.Makkawi S, Bukhari JI, Salamatullah HK, et al. Endovascular thrombectomy after anterior circulation large vessel ischemic stroke: an updated meta-analysis. Syst Rev. 2024;13(1):255. https://doi.org/10.1186/s13643-024-02670-6
16.Morsi RZ, Elfil M, Ghaith HS, et al. Endovascular thrombectomy for large ischemic strokes: An updated living systematic review and meta-analysis of randomized clinical trials. J Neurol Sci. 2024;460:123003. https://doi.org/10.1016/j.jns.2024.123003
17.Uchida K, Rinkel LA, Ospel JM, Diprose WK, Goyal M. A systematic review of randomized controlled trials of endovascular therapy for stroke on mortality and disability. J Neurol Sci. 2024;460:122991. https://doi.org/10.1016/j.jns.2024.122991
18.Hukamdad M, Biller J, Testai FD, Trifan G. Endovascular thrombectomy for large core volume acute ischemic stroke. Updated systematic review and meta-analysis. J Stroke Cerebrovasc Dis. 2025;34(1):108135. https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.108135
19.Sarraj A, Yoshimura S, Thomalla G, et al. Mechanical thrombectomy for large ischemic stroke: a critical appraisal of evidence from 6 randomized controlled trials. Stroke. 2025;56(7):1917-27. https://doi.org/10.1161/STROKEAHA.125.050402
20.Longoni M, Giacomozzi S, Pantoni L, Vidale S. Endovascular treatment in ischemic strokes with large infarct core: an updated systematic review and meta-analysis of randomized controlled trials. Neurol Sci. 2025;46(2):801-6. https://doi.org/10.1007/s10072-024-07781-5
21.Gharaibeh K, Aladamat N, Mierzwa AT, et al. Blood pressure after successful endovascular therapy: a systematic review and meta-analysis of randomized controlled trials. Ann Neurol. 2024;95(5):858-65. https://doi.org/10.1002/ana.26907
22.da Silva Neto EP, Ferreira LF, de Cardozo Hernandez ALC, et al. Blood pressure targets after successful reperfusion in mechanical thrombectomy for acute ischemic stroke: an updated systematic review and meta-analysis of randomized clinical trials. Neurol Sci. 2024;45(8):3879-86. https://doi.org/10.1007/s10072-024-07458-z
23.Minhas JS, Chithiramohan T, Wang X, et al. Oral antiplatelet therapy for acute ischaemic stroke. Cochrane Database Syst Rev. 2022;1(1):CD000029/ https://doi.org/10.1002/14651858.CD000029.pub4
24.Bushnell C, Kernan WN, Sharrif AZ, et al. 2024 Guideline for the primary prevention of stroke: a guideline from the American Heart Association/American Stroke Association. Stroke. 2024;55(12):e344-424. https://doi.org/10.1161/STR.0000000000000475
25.Romoli M., Cariddi L.P., Longoni M., et al. Mechanical Thrombectomy in Ischemic Stroke with a Large Infarct Core: A Meta-Analysis of Randomized Controlled Trials. J. Clin. Med. 2024, 13(15), 4280. https://doi.org/10.3390/jcm13154280
26.Schneider AM, Regenhardt RW, Dmytriw AA, et al. Cerebroprotection in the endovascular era: an update. J Neurol Neurosurg Psychiatry. 2023;94(4):267-71. https://doi.org/10.1136/jnnp-2022-330379
27.Chen Y, Wang S, Xu S, Xu N, Zhang L, Zhou J. Current advances in neurocritical care. J Intensive Med. 2024;5(1):23-31. https://doi.org/10.1016/j.jointm.2024.04.005
28.Benjamin W. Y. Lo and Hitoshi Fukuda. Advances in ischemic stroke treatment: Current and future therapies. 2025; Volume 14, P. 1783-1796. https://doi.org/10.1007/s40120-025-00810-1
29.Mekbib DB, Han J, Zhang L, et al. Virtual reality therapy for upper limb rehabilitation in patients with stroke: a meta-analysis of randomized clinical trials. Brain Inj. 2020;34(4):456-65. https://doi.org/10.1080/02699052.2020.1725126
30.Liang S, Hong ZQ, Cai Q, et al. Effects of robot-assisted gait training on motor performance of lower limb in poststroke survivors: a systematic review with meta-analysis. Eur Rev Med Pharmacol Sci. 2024;28(3):879-98. 31.Mansour S, Ang KK, Nair KPS, et al. Efficacy of brain-computer interface and the impact of its design characteristics on poststroke upper-limb rehabilitation. Clin EEG Neurosci. 2022;53(1):79-90. https://doi.org/10.1177/15500594211009065
32.Saikaley M, McIntyre A, Pauli G, Teasell R. A systematic review of randomized controlled trial characteristics for interventions to improve upper extremity motor recovery post stroke. Top Stroke Rehabil. 2023;30(4):323-32. https://doi.org/10.1080/10749357.2022.2035578
33.Yang FA, Lin CL, Cho SY, et al. Short- and long-term effects of repetitive transcranial magnetic stimulation on poststroke visuospatial neglect: a systematic review and meta-analysis of randomized controlled trials. Am J Phys Med Rehabil. 2023;102(6):522-32. https://doi.org/10.1097/PHM.0000000000002151