Pharmacotherapy of cerebral ischemia.
BACKGROUND
Ischemic stroke remains one of the leading causes of death and disability in the developed world. Despite many promising preclinical results, the only pharmacologic treatments proven effective in improving clinical outcome following ischemic stroke until now are administration of aspirin and acute thrombolysis using tissue-plasminogen activator.


OBJECTIVE
To review currently approved pharmacologic therapies as well as promising future treatment strategies for acute ischemic stroke.


METHODS
We performed an exhaustive PubMed search for articles published from 1950 through 2009 describing pharmacotherapy of acute ischemic stroke, focusing on agents that are currently in Phase III trials or approved for clinical use. Following this review, we present our interpretation of the existing literature and our vision of the future of pharmacotherapy for ischemic stroke.


CONCLUSIONS
Since the clinical success of the first intravenous thrombolytic, many studies have sought to further characterize the ideal patient population and to extend the therapeutic time window for pharmacologic thrombolysis. Additionally, despite the many failures of neuroprotective trials, several promising agents are currently undergoing Phase III investigation. With the advent of interventional techniques enabling local delivery of therapeutics into the region of the thrombus, the future of pharmacotherapy for ischemic stroke will probably include a combination of interventional techniques and pharmacotherapy.
Ducruet
Andrew F
AF
Columbia University, Department of Neurological Surgery, 710 West 168th Street, New York, NY 10032, USA. afd12@columbia.edu
Grobelny
Bartosz T
BT
Zacharia
Brad E
BE
Hickman
Zachary L
ZL
Yeh
Mason L
ML
Connolly
E Sander
ES
D002545:Brain Ischemia / Q000188:drug therapy*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D018696:Neuroprotective Agents / Q000627:therapeutic use; D020521:Stroke / Q000517:prevention & control; D015912:Thrombolytic Therapy
D005343:Fibrinolytic Agents; D018696:Neuroprotective Agents