Reperfusion stroke injury and brain atrophy: a penumbra of progressive cognitive decline

Reperfusion therapy has revolutionized ischemic stroke management, yet its potential to induce secondary reperfusion brain injury (RBI) has emerged as a critical concern. This editorial explores the mechanistic links between RBI, subsequent brain atrophy, and progressive cognitive decline. Inflammation, oxidative stress, astrocytic activation, and disruption of the neurovascular unit are implicated in this pathological continuum. Drawing from current literature, we discuss the potential role of astrocytosis in amyloid-β dynamics and highlight the urgent need for biomarkers and neuroprotective strategies that extend beyond acute care. Understanding these interconnections may reshape long-term stroke management and guide future research toward mitigating post-stroke neurodegeneration.