5 Ukrainian Neurosurgical Journal. Vol. 26, N4, 2020 http://theunj.org Обзорная статья = Review article = Оглядова стаття Ukr Neurosurg J. 2020;26(4):5-19 doi: 10.25305/unj.209118 Клеточная терапия при ишемическом инсульте Ботев В.С., Гриб В.А. К   , И- Ф   , И- Ф, У Поступила в редакцию 31.07.2020 Принята к публикации 02.11.2020 Адрес для переписки: Ботев Вячеслав Семенович, Кафедра неврологии и нейрохирургии, Ивано- Франковский национальный медицинский университет, ул. Галицкая, 2, Ивано-Франковск, 76018, Украина, e-mail: vyacheslav56@yahoo.co.uk И  ,                . С ,  2018 .  15     6   . Е                (rtPA)   ,      10  1%  . О           . О          ,           ,   ,       . П      . О     (  ,   ,   ),  ,            (,   ). П        . П   15     2015 .   ,     513 . П       . Ключевые слова: ишемический каскад; клеточная терапия; стволовые клетки; трансплантация Copyright © 2020 Viacheslav S. Botev, Viktoria A. Gryb This work is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ Cell therapy for ischemic stroke Viacheslav S. Botev, Viktoria A. Gryb Department of Neurology and Neurosurgery, Ivano-Frankivsk National Medical University, Ivano- Frankivsk, Ukraine Received: 31 July 2020 Accepted: 02 November 2020 Address for correspondence: Viacheslav S. Botev, Department of Neurology and Neurosurgery, Ivano-Frankivsk National Medical University, 2 Halytska st., Ivano- Frankivsk, 76018, Ukraine, e-mail: vyacheslav56@yahoo.co.uk Stroke is the second, and in some countries the third cause of mortality in the population and one of the causes of disability in the adult population. According to statistics, in 2018, 15 million cases of stroke and 6 million deaths were diagnosed, The only currently approved treatments for acute stroke are intravenous tissue plasminogen activator (rtPA) and intra-arterial thrombectomy, which are used in less than 10% and 1% of patients, respectively. The literature review is devoted to the pathophysiology and molecular mechanisms of damage in cerebral ischemia. The modern concept of two strategies of cell therapy is discussed: neuroprotection and remodeling; the role of stem cells in reducing local and systemic infammation, neurogenesis and angiogenesis, increasing neuronal plasticity, and protecting the blood- brain barrier, the role of paracrine factors and extracellular vesicles is shown. Methods of stem cell delivery are described: direct intracerebral transplantation, intraventricular and intrathecal, intravenous and intraarterial; the number of cells, their type and optimal delivery time depending on the acute, subacute and chronic periods of stroke. We also described recently designed the radially branched deployment (RBD) device and Cleveland multiport catheter for convection-enhanced delivery in which a cell-delivery catheter can be deployed at various angles and depths from a single longitudinal cannula. Finally, data on the completed 15 clinical trials from 2015 to the present, in which 513 patients took part, are presented. A detailed analysis of the ef fcacy and safety of cell therapy has been carried out. Keywords: ischemic cascade; cell therapy; stem cells; stem cells delivery; clinical trials.