The ischemic penumbra: a new opportunity for neuroprotection.
The development of acute stroke therapies has yielded only limited success and many failures in multiple clinical trials. The target of acute stroke therapy is that portion of the ischemic region that is still potentially salvageable, i.e. the ischemic penumbra. Neuroprotective drugs have the potential to prevent a portion of the ischemic penumbra from evolving into infracted tissue and designing trials that target neuroprotective drugs at patients with persistent penumbra should enhance the likelihood of a positive outcome. Currently, diffusion and perfusion MRI has the potential to approximate the location and persistence of the ischemic penumbra and can be used in clinical trials to select appropriate patients for inclusion and to evaluate a meaningful treatment effect. Perfusion CT may also have similar capabilities. Use of these imaging modalities in clinical trials and ultimately in clinical practice will likely help in the development and utilization of novel neuroprotective drugs.
Fisher
Marc
M
Department of Neurology, University of Massachusetts Medical School, Worcester, 01605, USA. fisherm@ummhc.org
D000818:Animals; D001557:Benzenesulfonates / Q000494:pharmacology / Q000627:therapeutic use; D001921:Brain / Q000187:drug effects / Q000473:pathology; D002545:Brain Ischemia / Q000188:drug therapy / Q000473:pathology*; D002986:Clinical Trials as Topic; D038524:Diffusion Magnetic Resonance Imaging; D015195:Drug Design; D006801:Humans; D018810:Magnetic Resonance Angiography; D018696:Neuroprotective Agents / Q000494:pharmacology / Q000627:therapeutic use; D018579:Patient Selection; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use; D020521:Stroke / Q000188:drug therapy / Q000473:pathology*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000235:genetics / Q000494:pharmacology / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed / Q000379:methods
D001557:Benzenesulfonates; D018696:Neuroprotective Agents; D011994:Recombinant Proteins; C120851:disufenton sodium; D010959:Tissue Plasminogen Activator