title: Focal cerebral ischemia and neurovascular protection: a bench-to-bedside update.
abstract: OBJECTIVE
  To date, many pharmacological approaches, or combination of approaches, have been applied to experimental models of focal cerebral ischemia (FCI), but their translation to clinically effective agents has proved unsuccessful. To date, only thrombolysis with recombinant tissue-type plasminogen activator, or other 'clot-breaking' or 'clot-removal' approaches, have proved effective for acute stroke. This review, therefore, focuses on the 'vascular' phenomena involved in the development of FCI.
  
  
  RESULTS
  Recent advances in the experimental literature on FCI describe the microvascular characteristics of the ischemic penumbra, the consequences of cortical spreading depression on impairing cerebral perfusion, and the potential neuroprotective mechanisms of ischemic preconditioning via antithrombotic effects on the neurovascular unit.
  
  
  CONCLUSIONS
  This review provides a perspective about the neurovascular components contributing to the pathophysiology of FCI, and some relevant clinical strategies available on the horizon that hold promise for improved cerebral perfusion in FCI.
authors.affiliation: aDepartment of Neurology bDivision of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Tasker
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Duncan
mesh_terms: D000293:Adolescent; D002545:Brain Ischemia / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods*; D005343:Fibrinolytic Agents; D006801:Humans; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D020521:Stroke / Q000188:drug therapy / Q000503:physiopathology* / Q000517:prevention & control; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000187:drug effects / Q000378:metabolism*
chemical_list: D005343:Fibrinolytic Agents; D018696:Neuroprotective Agents; C067262:PLAT protein, human; D010959:Tissue Plasminogen Activator