Efficacy of Mexidol in combination with cerebral revascularization in the treatment of ischemic stroke

Alasheev A.M.; Lantsova E.V.

doi:https://doi.org/10.17116/jnevro202412403267

Close metadata

Recommended articles:

Early antithrombotic protection of the brain in patients with ischemic stroke. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(8-2):5-10

Approaches to medical rehabilitation of patients with post-stroke hemianopsia. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(8-2):20-25

Epileptogenesis and risk factors of symptomatic epileptic seizures in patients with acute cerebrovascular accidents. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(8-2):26-31

Associations of genetic polymorphisms in key inflammatory response genes with the risk of chronic apical periodontitis development. Russian Journal of Stomatology. 2025;(2):52-56

Cerebrolysin with reperfusion therapy in ischemic stroke: a prospective analysis of multimodal brain imaging data from the CEREHETIS trial. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(6):84-98

Prediction of mortality in severe ischemic stroke during COVID-19 in patients with multiorgan dysfunction. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(6):120-127

The impact of Mexidol on improving quality of life parameters and functional kidney status as part of complex therapy for cognitive impairments in comorbid patients with microalbuminuria against the background of arterial hypertension and type 2 diabetes mellitus. Russian Journal of Cardiology and Cardiovascular Surgery. 2025;(4):478-478

Effect of uric acid on the progression of Parkinson’s disease: Myth or reality?. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(7):7-14

Prediction of restoration of functional activity of paretic limbs in patients who have suffered an ischemic stroke. Problems of Balneology, Physiotherapy and Exercise Therapy. 2025;(3):31-40

A clinical case of treating a patient with severe ischemic stroke and cancer. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(8):114-117

Abstract:

Stroke is an acute life-threatening condition; its outcome is determined by the degree of damage to brain tissue, the quality and speed of medical care in the first minutes and hours after its occurrence. The main mechanism of brain tissue damage during both ischemia and reperfusion is oxidative stress. The review covers adverse influence oxidative stress at the cerebral ischemia and reperfusion periodes of ischemic stroke. The results of preclinical studies demonstrating the ability of Mexidol to neutralize the effects of free radicals and activate antioxidant protection are presented. Data from clinical studies of the use of Mexidol in combination with thrombolysis in patients with ischemic stroke are reviewed.

Keywords:

stroke

revascularization

oxidative stress

Mexidol

Authors:

Alasheev A.M.

Regional Clinical Hospital No. 1

ORCID: 0000-0003-1610-2127

Lantsova E.V.

Sciencefiles

ORCID: 0000-0002-1412-0711

Received:

23.11.2023

Accepted:

23.11.2023

Close metadata

References:

GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990—2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021;20(10):795-820. https://doi.org/10.1016/S1474-4422(21)00252-0
Klochihina OA, Shprakh VV, Stakhovskaya LV, Polunina EA. An analysis of the long-term stroke morbidity and mortality in the regions of the Russian Federation included in the Federal patient assistance reorganization program. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2020;120(12-2):37-41. (In Russ.). https://doi.org/10.17116/jnevro202012012237
Schapira AHV. Mitochondrial diseases. Lancet. 2012;379(9828):1825-1834. https://doi.org/10.1016/S0140-6736(11)61305-6
Uzlova EV, Zimatkin SM. ATF-sintaza mitokhondrii. Zhurnal Grodnenskogo Gosudarstvennogo Meditsinskogo Universiteta. 2020;18(6):648-654. (In Russ.). https://doi.org/10.25298/2221-8785-2020-18-6-648-654
Pozhilova EV, Novikov VE, Levchenkova OS. Reactive oxygen species in cell physiology and pathology. Vestnik Smolenskoi Gosudarstvennoi Meditsinskoi Akademii. 2015;14(2):13-22. (In Russ.).
Lu H, Hu H, He Z, et al. Therapeutic imaging window of cerebral infarction revealed by multisequence magnetic resonance imaging: An animal and clinical study. Neural Regen Res. 2012;7(31):2446-2455.
Sun MS, Jin H, Sun X, et al. Free Radical Damage in Ischemia-Reperfusion Injury: An Obstacle in Acute Ischemic Stroke after Revascularization Therapy. Oxid Med Cell Longev. 2018;2018:3804979. https://doi.org/10.1155/2018/3804979
Kontos HA. Oxygen radicals in cerebral ischemia: the 2001 Willis lecture. Stroke. 2001;32(11):2712-2716. https://doi.org/10.1161/hs1101.098653
Shichkova YuS. Role of cellular signals ways in developmentof consequences of oxidative stress. Nauchnyi Elektronnyi Zhurnal Meridian. 2020;(3):6-8. (In Russ.).
Kamchatnov PR, Mikhailova NA, Zhdanova SV. Korrektsiya svobodnoradikal’nogo okisleniya u bol’nykh s rasstroistvami mozgovogo krovoobrashcheniya. Trudnyi Patsient. 2010;8(6-7):26-30. (In Russ.).
Semenenko AI. Sostoyanie energeticheskogo metabolizma golovnogo mozga krys na fone vvedeniya nekotorykh infuzionnykh rastvorov pri ishemii-reperfuzii. Tikhookeanskii Meditsinskii Zhurnal. 2014;(4 (58)):60-62. (In Russ.).
Shcheglov DV, Konotopchik SV, Chebanyuk SV, et al. Evolyutsiya invazivnykh i neinvazivnykh vmeshatel’stv pri ostroi tserebral’noi ishemii. Ukraїns’ka Іnterventsіina Neiroradіologіya Ta Khіrurgіya. 2015;(2 (12)):74-84. (In Russ.).
Jurcau A, Ardelean AI. Oxidative Stress in Ischemia/Reperfusion Injuries following Acute Ischemic Stroke. Biomedicines. 2022;10(3):574. https://doi.org/10.3390/biomedicines10030574
Kislitsyn YuV, Tatarenko SA. Epidemiologiya insul’tov v Kirovskoi oblasti (po rezul’tatam deyatel’nosti Kirovskogo regional’nogo sosudistogo tsentra v 2016 godu). Meditsinskii Al’manakh. 2017;(5 (50)):22-25. (In Russ.).
Demin TV, Saikhunov MV, Musin ShG, Khasanova DR. Reperfuzionnaya terapiya u bol’nykh s ishemicheskim insul’tom v usloviyakh sosudistykh tsentrov Respubliki Tatarstan. Farmateka. 2013;(19):99-103. (In Russ.).
Kataev PV, Timchenko LV, Andreev SM, Aliev KB. Opyt primeneniya endovaskulyarnoi reperfuzionnoi terapii ishemicheskogo insul’ta v GBUZ «NII — KKB №1 im. prof. S.V. Ochapovskogo». Vestnik Rossiiskoi Voenno-Meditsinskoi Akademii. 2019;(S3):23-29. (In Russ.)
Domashenko MA, Maksimova MYu, Loskutnikov MA, Nikonov AA. Opyt sistemnogo trombolizisa v lechenii patsientov s ishemicheskim insul’tom. Nervnye Bolezni. 2012;(4):2-6. (In Russ.).
Shilonosova IV, Shestakov VV. Opyt tromboliticheskoi terapii u patsientov v ostreishii period ishemicheskogo insul’ta v gorode Permi. Permskii Meditsinskii Zhurnal. 2016;33(5):15-22. (In Russ.).
Skvortsova VI, Gubskii LV, Shamalov NA, et al. Osobennosti bazisnoi terapii ishemicheskogo insul’ta pri provedenii sistemnoi tromboliticheskoi terapii. Doktor Ru. 2007;(5):2-4. (In Russ.).
Sen’ko KV, Fedulov AS, Kurochkin AV, Golovataya EA. Predicting the Outcome of Thrombolytic Therapy in Patients with Ischemic Stroke Based on the Use of Neural Network Analysis. Nevrologiya I Neirokhirurgiya Vostochnaya Evropa. 2020;10(3):12-16. (In Russ.). https://doi.org/10.34883/PI.2020.10.3.031
Klestov KB, Kulikov YuV, Sultanov IR, et al. Endovaskulyarnaya reperfuzionnaya terapiya pri ishemicheskom insul’te v usloviyakh RSTs 1 RKB Izhevska. Mezhdunarodnyi Zhurnal Interventsionnoi Kardioangiologii. 2017;(48-49):50-50. (In Russ.).
Prazdnichkova EV, Alasheev AM, Belkin AA, Volkova LI. Systemic thrombolysis in patients with ischemic stroke in Sverdlovsk region. Ural’skii Meditsinskii Zhurnal. 2014;9(123):12-19. (In Russ.).
Shamalov NA. Problemy i perspektivy reperfuzionnoi terapii pri ishemicheskom insul’te v Rossii. Farmateka. 2015;9(302):14-18. (In Russ.).
Chefranova ZhYu, Makotrova TA, Udachin VA, Koledintseva EV. Efficacy of mexidol in the combination with thrombolytic therapy in patients with ischemic stroke. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2012;112(4):49-52. (In Russ.).
Botsina AYu, Sukhanova EO, Anisimov KV, et al. Primenenie metodov reperfuzionnoi terapii u patsientov s ishemicheskim insul’tom v statsionare insul’tnoi seti Moskvy (GKB im. I.V. Davydovskogo). Moskovskaya Meditsina. 2019;6:34-38. (In Russ.).
Rumyantseva SA, Fedin AI, Sokhova ON.The antioxidant treatment of brain ischemic lesions. Zhurnal nevrologii I psikhiatrii im. S.S. Korsakova. 2011;4(2):20-28. (In Russ.).
Voronina TA. Mexidol: the spectrum of pharmacological effects. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2012;112(12):86-90. (In Russ.).
Vertkin AL. Effektivnaya tkanevaya protivoishemicheskaya terapiya sosudistykh zabolevanii golovnogo mozga razlichnogo geneza. Kardiovaskulyarnaya Terapiya i Profilaktika. 2016;15(2):69-78. (In Russ.).
Calvert JW, Cahill J, Yamaguchi-Okada M, Zhang JH. Oxygen treatment after experimental hypoxia-ischemia in neonatal rats alters the expression of HIF-1 alpha and its downstream target genes. J Appl Physiol. 1985. 2006;101(3):853-865. https://doi.org/10.1152/japplphysiol.00268.2006
Yakusheva EN, Mylnikov PYu, Chernykh IV, Shchulkin AV. Mexidol effect on the factor induced by hypoxia HIF-1α expression in the rat cerebral cortex in ischemia. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2017;117(10):87-91. (In Russ.). https://doi.org/10.17116/jnevro201711710187-91
Yakusheva EN, Mylnikov PYu, Chernykh IV, Shchulkin AV. An effect of mexidol on the expression of the transcription factor Nrf2 in the rat cerebral cortex in ischemia. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2018;118(5):64-68. (In Russ.). https://doi.org/10.17116/jnevro20181185164
Amaro S, Soy D, Obach V, et al. A pilot study of dual treatment with recombinant tissue plasminogen activator and uric acid in acute ischemic stroke. Stroke. 2007;38(7):2173-2175. https://doi.org/10.1161/STROKEAHA.106.480699
Kurganov NA, Geras’kina MM, Nizin PYu, et al. Farmakologicheskie podkhody k profilaktike reperfuzionnykh porazhenii golovnogo mozga v eksperimente. Mediko-Farmatsevticheskii Zhurnal «Pul’s». 2017;19(12):252-256. (In Russ.).
Voronkov AV, Pozdnyakov DI, Khuri EI, et al. Otsenka antioksidantnoi aktivnosti 4-gidroksi-3, 5-ditretbutilko-richnoi kisloty, meksidola i tioktovoi kisloty na modeli fokal’noi ishemii golovnogo mozga. Voprosy Biologicheskoi Meditsinskoi I Farmatsevticheskoi Khimii. 2017;60(2):48-52. (In Russ.).
Makarova LM. Neiroprotektornoe deistvie preparata «Meksidol» pri total’noi ishemii mozga (k voprosu o tselesoobraznosti primeneniya dannogo preparata pri gravitatsionnykh peregruzkakh). Byulleten’ Eksperimental’noi Biologii I Meditsiny. 2006;131:48-54. (In Russ.)
Voronina TA, Kraineva VA, Zolotov NN, et al. The role of oxidative stress in hemorrhagic stroke and restorative effects of Mexidol. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2022;122(8-2):65-71. (In Russ.). https://doi.org/10.17116/jnevro202212208265
Lutskiĭ MA. An analysis of mexidol efficacy in the complex treatment of patients with ischemic stroke. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2010;110(4-2):57-59. (In Russ.).
Skvortsova VI, Stakhovskaya LV, Nartsissov YaR, et al. Randomizirovannoe dvoinoe slepoe platsebo-kontroliruemoe issledovanie effektivnosti i bezopasnosti meksidola v kompleksnoi terapii ishemicheskogo insul’ta v ostrom periode. Insul’t. 2006;18:47-54. (In Russ.).
Godunova AR, Rakhimova AA, Leontyeva OI, et al. An influence of submaximal doses of mexidol on oxidant stress and inflammation in the acute period of ischemic stroke. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2018;118(2):27-30. (In Russ.). https://doi.org/10.17116/jnevro20181182127-30
Odinak MM, Ianishevskiĭ SN, Tsygan NV, et al. The use of succinates for the correction of metabolic disorders in the penumbra in patients with stroke. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2013;113(12-2):55-60. (In Russ.).
Rumyantseva SA, Evseev VN, Eliseev EV. Antioksidantnaya terapiya pri ostrom ishemicheskom insul’te. Nervnye Bolezni. 2009;(3):8-12. (In Russ.).
Lyang OV, Kochetov AG. The use of mexidol in chronic cerebral ischemia. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2013;113(12):126-129. (In Russ.).
Stakhovskaya LV, Shamalov NA, Khasanova DR, et al. Results of a randomized double blind multicenter placebo-controlled, in parallel groups trial of the efficacy and safety of prolonged sequential therapy with mexidol in the acute and early recovery stages of hemispheric ischemic stroke (EPICA). Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2017;117(3-2):55-65. (In Russ.). https://doi.org/10.17116/jnevro20171173255-65
Loskutnikov MA, Domashenko MA, Vakin TM, et al. The trial of the efficacy and safety of sequential therapy with Mexidol forte 250 in acute and early recovery stages of hemispheric ischemic stroke. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2020;120(10):22-26. (In Russ.). https://doi.org/10.17116/jnevro202012010122
Strel’nikova IA, Svetkina AA, Androfagina OV. The efficacy and safety of Mexidol Forte 250 as part of long-term sequential therapy in patients with carotid stroke. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2020;120(3-2):54-58. (In Russ.). https://doi.org/10.17116/jnevro202012003254
Yastrebtseva IA, Krivonogov VV, Belova VI, et al. Dinamika umstvennykh funktsii u patsientov s tserebral’nym insul’tom v zavisimosti ot dozozavisimoi neirometabolicheskoi podderzhki. Vrach. 2018;29(12):30-32. (In Russ.). https://doi.org/10.29296/25877305-2018-12-07
Knni KS, Dyomin TV, Adeeva LB. Effect of mexidol on the efficiency of intravenous thrombolytic therapy for ischemic stroke during the therapeutic window. Neurology, Neuropsychiatry, Psychosomatics. 2018;10(3):86-90. (In Russ.). https://doi.org/10.14412/2074-2711-2018-3-86-90
Musin ShG. Opyt primeneniya meksidola pri tromboliticheskoi terapii ishemicheskogo insul’ta. Meksidol in the clinic and experimented. Bulletin of Experimental Biology and Medicine Appendix 1. Publishing House of the Russian Academy of Medical Sciences. 2012;37. (In Russ.)
Astrakov SV. Vozmozhnosti antioksidantnoi terapii v ogranichenii vtorichnogo povrezhdeniya mozga u neiroreanimatsionnykh bol’nykh. Byulleten’ Eksperimental’noi Meditsiny. 2006;176(34):178-181. (In Russ.).
Cherniy V, Andronova I, Cherniy T, et al. The energy-synthesizing role of succinate in the recovery of consciousness in patients with ischemic stroke in an acute period. J Neurosci. 2018;6(1):31-40.
Khaydarova D, Xaydarov N, Khodjyeva D. Clinical Basis for the Development of Neuroprotective Therapy in Acute Ischemic Stroke. Int J Health Sci. 2022;(I):4177-4183. https://doi.org/10.53730/ijhs.v6nS1.5819
Vasil’eva IG, Globa MV, Chopik NG, Snitsar ND. Evaluation of immune and biochemical markers in patients with aneurysmal subarachnoid haemorrhage. Nevrologiya I Neirokhirurgiya Vostochnaya Evropa. 2013;(2):69-79. (In Russ.).