Intra-Arterial Stem Cell Therapy in Ischemic Stroke: A Systematic Review of Clinical Outcomes and Safety
DOI:
https://doi.org/10.46799/jhs.v7i9.2876Keywords:
ischemic stroke, stem cell therapy, intra-arterial, neurorestoration, clinical outcomes, safetyAbstract
Ischemic stroke remains a major cause of mortality and long-term disability. Restricted therapeutic windows and persistent disability following reperfusion therapy have encouraged the development of neurorestorative approaches. Intra-arterial stem cell delivery may increase targeted cell exposure to ischemic brain tissue; however, its clinical safety and efficacy remain uncertain. This systematic review was conducted according to the PRISMA 2020 guidelines. PubMed, Scopus, and Google Scholar were searched using terms related to ischemic stroke, stem cells, bone marrow mononuclear cells, mesenchymal stem cells, CD34, intra-arterial delivery, NIHSS, modified Rankin Scale, and safety. Human studies using intra-arterial stem cell administration and reporting clinical or safety outcomes were narratively synthesized. Fifteen records were identified, 14 were screened, and eight reports met the inclusion criteria. These eight reports represented seven independent clinical cohorts because one publication was a diffusion tensor imaging (DTI) substudy of the IBIS trial. The included evidence comprised randomized controlled trials, phase I/II studies, feasibility or single-arm studies, and one case report. Intra-arterial administration was generally feasible and demonstrated a relatively favorable safety profile. Improvements in NIHSS, modified Rankin Scale, Barthel Index, or imaging outcomes were reported in several studies; however, clinical benefits were not consistently statistically significant. Interpretation was limited by small sample sizes, uncontrolled study designs, combined interventions, and substantial heterogeneity. Intra-arterial stem cell therapy demonstrates neurorestorative potential with a generally reassuring early safety profile, but its efficacy remains unproven. Larger randomized controlled trials with standardized protocols and long-term follow-up are required before routine clinical application can be recommended.
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