Tissue rescue therapy for acute ischaemic stroke.
Despite population-based declines in stroke mortality, the individual mortality rate in ischaemic stroke approaches 20%, with substantial morbidity in the majority of survivors. Reduction of this rate will depend on the advent of effective acute tissue rescue therapy. Based on improved understanding of the pathophysiology of acute ischaemia, it is now recognised that the time window for therapeutic intervention is only a few hours after stroke onset. The major therapeutic strategies currently being investigated include firstly approaches to improve reperfusion after ischaemia, such as thrombolysis, haemorheological and antithrombotic therapies, and secondly strategies for neuronal protection such as calcium channel and NMDA antagonists and free radical inhibitors. Based on promising animal and early human studies, the results of large randomised, placebo-controlled clinical trials are expected in the near future and should have a profound effect on acute stroke management.
Davis
S M
SM
Department of Neurology, Clinical Neuroscience Centre, Royal Melbourne Hospital, Victoria, Australia.