Abstract: Brain cytoprotection has long been a highly regarded yet challenging research direction in the field of acute ischemic stroke treatment. In the era of reperfusion therapy, with continuous advances in intravenous thrombolysis and endovascular therapy, the therapeutic goals of ischemic stroke have extended beyond large vessel recanalization to meaningful tissue-level benefit. Practical clinical demands such as alleviating ischemia-reperfusion injury, stabilizing the neurovascular unit, and expanding salvageable brain tissue have brought brain cytoprotection research back to the clinical forefront. Edaravone dexborneol, a compound preparation of edaravone and dexborneol, exerts multi-target effects including scavenging oxygen free radicals and inhibiting the inflammatory cascade, and has become one of the most evidence-based agents for brain cytoprotection in ischemic stroke in China. In recent years, relevant Chinese guidelines have gradually recommended it as an available brain cytoprotective agent, whereas international guidelines have not yet made routine recommendations for the clinical use of brain cytoprotective agents but have acknowledged renewed research opportunities in the context of reperfusion therapy for ischemic stroke. This review summarises the research background of brain cytoprotective agents, the positioning of brain cytoprotective strategies in international guidelines, and the pharmacological basis and current evidence for edaravone dexborneol. It summarises the design features, main findings, and clinical implications of key randomized controlled trials and real‑world cohort studies in this field. Additionally, based on ongoing registered studies, it discusses future prospects of edaravone dexborneol in pre‑hospital ultra-early intervention for ischemic stroke, combination treatment with reperfusion therapy, and application in precisely stratified or special populations, aiming to provide a reference for research and clinical practice in brain cytoprotection for ischemic stroke.

Key words: Acute ischemic stroke; Brain cytoprotection; Edaravone dexborneol; Ischemia-reperfusion injury

摘要： 脑细胞保护是急性缺血性卒中治疗领域中长期被关注且具有挑战性的重要方向。在静脉溶栓和血管内治疗日益完善的再灌注时代，缺血性卒中的治疗目标已由单纯大血管开通进一步延伸至组织层面的真正获益。减轻缺血再灌注损伤、稳定神经血管单元、扩大可挽救脑组织等切实需求，推动脑细胞保护研究回到临床前沿。依达拉奉右莰醇是依达拉奉和右莰醇的复方制剂，兼具清除氧自由基和抑制炎症级联效应等多靶点作用，是目前我国缺血性卒中脑细胞保护研究中证据积累最充分的药物之一。近年来，我国相关指南已逐渐将其列为可应用的脑细胞保护剂；虽然国际相关指南尚未对脑细胞保护剂的临床应用做出常规推荐，但均强调在缺血性卒中再灌注治疗时代背景下，脑细胞保护治疗存在新的研究契机。本文围绕脑细胞保护的研究背景、国际指南对脑细胞保护策略的定位，以及依达拉奉右莰醇的药理学基础及其循证证据展开综述，总结该领域重要的临床随机对照试验及真实世界队列研究的设计特点、主要结果与临床意义，并结合正在进行的注册研究，对依达拉奉右莰醇未来在缺血性卒中院前超早期干预、与再灌注联合治疗，以及在精准分层或特殊患者人群中的应用前景进行讨论，以期为缺血性卒中相关脑细胞保护研究与临床实践提供参考。

关键词: 急性缺血性卒中; 脑细胞保护; 依达拉奉右莰醇; 缺血再灌注损伤