Abstract: Acute ischemic stroke, a leading cause of global disability and mortality, faces a critical challenge of cerebral microcirculation disorders despite successful vascular recanalization. This narrative review synthesizes current evidence on the epidemiology, clinical significance, pathogenesis, assessment methods, and therapeutic strategies for post-recanalization microcirculatory dysfunction. Key findings from the literature reveal that microcirculation impairment, driven by hemodynamic instability, neutrophil-platelet interactions, fibrin deposition, endothelial/pericyte dysfunction, blood–brain barrier disruption, and oxidative stress, significantly contributes to futile recanalization and poor prognosis. Advanced imaging modalities, such as dynamic contrast-enhanced magnetic resonance imaging and two-photon microscopy, have emerged as pivotal tools for real-time evaluation of microvascular perfusion and permeability. Pharmacological interventions, including antiplatelet agents, neuroprotective drugs (e.g., butylphthalide), and traditional Chinese medicine (e.g., Danshen Chuanxiongqin), alongside non-pharmacological approaches such as normobaric hyperoxia and hypothermia therapy, demonstrate potential in mitigating microcirculatory injury. Recent clinical trials highlight promising strategies, such as glucagon-like peptide-1 receptor agonists and targeted thromboinflammatory therapies, whereas preclinical studies underscore the role of pericytes in regulating capillary flow and neurovascular coupling. However, challenges persist in translating these findings into clinical practice, necessitating standardized assessment protocols and personalized treatment regimens. This review underscores the imperative for multidisciplinary collaboration and innovative research to optimize cerebral microcirculation recovery and help improve the treatment efficacy of acute ischemic stroke.
Z et al. (Fri,) studied this question.