439a microsurgical anastomosis between the superfi cial temporal and the middle artery
branches, to reroute blood in cases with inoperable cerebral arterial obstruction. The
procedure was popular in the 1970s but the results were variable as some patients
showed improvement and others not. A multicenter Cooperative study in 1985
reviewed 1,400 patients and concluded that the operation had no advantage over
medical management, and was useless. The poorly designed study included many
failures where the procedure should not have been done in the fi rst place. The study
ignored a 1977 publication in which response to HBO by recovery of neurological
defi cit in chronic post-stroke stage in 17 out of 35 patients tested was used as a sign
of reversibility of cerebral function and an indication for EC/IC bypass and all of
these patients improved (Holbach et al. 1977 ).
Personalized Cell Therapy for Management of Stroke
Numerous studies provide evidence that hematopoietic stem cells, either after stim-
ulation of endogenous stem cell pools or after exogenous hematopoietic stem cell
application (transplantation), improve functional outcome after ischemic brain
lesions (Jain 2015b ). Various underlying mechanisms include transdifferentiation
into neural lineages, neuroprotection through trophic support, and cell fusion.
Functional improvement can occur months after stem cell transplantation when the
grafted cells have disappeared without histological evidence of replacement of the
infarcted tissue and this has been attributed to paracrine effect of stem cells. Several
clinical studies employing autologous adult stem cell-based strategies, considered
to be a form of personalized therapy of stroke, hold great promise.
Management of Stroke According to Stage
For a complex disorder such as stroke with several stages and manifestations, it is
diffi cult to specify a single therapy. As a guide to management of stroke from acute to
chronic stages, a scheme suggested by the author of this report is shown in Table 12.6.
Table 12.6 Role of cell therapy in management of stroke according to stageStage of stroke Duration Measure required Methods
Onset Minutes Neuroprotection Hyperbaric oxygen
Pharmaceutical
Hyperacute Onset to 6 h Recanalization of obstructed
arteries and restoration of
blood fl ow
Thrombolysis
Embolectomy
Stenting
Subacute 2–3 days Start of repair Cell therapy
Chronic Weeks to years Regeneration Hyperbaric oxygen
Rehabilitation
Surgical revascularization
© Jain PharmaBiotech
Personalized Management of Stroke