Important advances have been made in reperfusion therapies for acute ischemic stroke. However, a majority of patients are either ineligible for or do not respond to treatments and continue to have considerable functional deficits. Stroke results in a pathological disruption of the neurovascular unit (NVU) that involves blood-brain barrier leakage, glial activation, neuronal damage and chronic inflammation, all of which create a microenvironment that hinders recovery. Therefore, finding ways to promote central nervous system recovery remains the holy grail of stroke research. Here we propose a conceptual framework to synthesize recent progress in the field, which is currently dispersed and disconnected in the literature. We suggest that stroke recovery requires an integrated reprogramming process throughout the brain that occurs at multiple levels, including changes in gene expression, endogenous cellular transdifferentiation within the NVU, and reorganization of larger-scale neural and social networks.

© 2025. Springer Nature America, Inc.

在急性缺血性卒中的再灌注治疗方面已经取得了重要进展。然而，大多数患者要么不符合这些治疗方法的条件，要么对这些治疗方法没有反应，并继续存在显著的功能障碍。卒中会导致神经血管单元（NVU）病理性的破坏，包括血脑屏障泄漏、胶质细胞激活、神经元损伤和慢性炎症等，所有这些都会创造一个阻碍恢复的微环境。因此，寻找促进中枢神经系统恢复的方法仍然是卒中研究中的圣杯。在这里，我们提出了一种概念框架来综合该领域的最新进展，而目前这些进展在文献中是分散且不连贯的。我们认为，卒中恢复需要在整个大脑范围内进行整合的重编程过程，在多个层次上发生改变，包括基因表达的变化、NVU内内源性细胞转分化以及更大规模神经和社交网络的重组。

© 2025. Springer Nature America, Inc.