Ischemic stroke: Today and tomorrow

Objective: To review selected aspects of the current treatment of acute ischemic stroke and provide an overview of basic neuroscience research in cerebral ischemia that may be applicable to future therapies. Data Sources: Selected recent references dealing with current therapy of acute stroke and basic neuroscience developments in cerebrovascular disease from the past several years. Study Selection/Data Extraction: Whenever possible, recommendations concerning treatment were based on results of clinical trials; when such data were lacking, the authors present possible treatment approaches. Data Synthesis: Acute stroke is a heterogeneous process involving different etiologic mechanisms. Different types of stroke, however, may produce a similar cascade of physiologic and biochemical events leading to tissue damage. Calcium flux, glutamate excitotoxicity, platelet and leukocyte activation, free radical formation, and nitric oxide metabolism may be crucial focal points of future stroke therapy. Conclusions: Recent clinical trials have given scientific basis for some of our treatment approaches to ischemic stroke. Future treatments for stroke will likely focus on factors which modulate biochemical events occurring as a final common pathway to all forms of cerebral ischemia.