Stroke pathophysiology: management challenges and new treatment advances

ABSTRACT

Stroke is the second leading cause of death and the first cause of lost disabilityadjustedyears in developed countries. During the past decade, new developments inthrombolytic therapy have led to the implementation of emergency intervention protocolsfor the treatment of ischemic stroke, replacing the widespread sense of therapeuticnihilism in the past. Treatment with rtPA has shown to be effective within thefirst 3 hours following stroke onset and the FDA and the European Medical Agency(EMEA) have approved its use. Acknowledging the urgency and intricacies of stroke,Stroke Units allow the monitoring of physiological parameters in the acute phase ofstroke and are considered an important management tool that can significantlyimprove the quality of care provided to the patient. The concept of neuroprotectivetherapy for acute ischemic stroke to salvage tissue at risk and improve functional outcomeis based on sound scientific principles and extensive preclinical animal studiesdemonstrating efficacy. However, most neuroprotective drugs in clinical trials havefailed, possibly due to inadequate preclinical testing or flawed clinical developmentprograms. Several new treatment strategies are under development and are being tested.This review is directed at understanding the management of acute ischemic strokepathophysiology. We address the management challenges and new treatmentadvances by integrating the knowledge of possible pharmacological targets for acuteischemic stroke. We hope to shed new light upon the controversy surrounding themanagement of acute ischemic stroke in an attempt to elucidate why failed clinicaltrials continue to occur despite promising neuroprotective preclinical studies (AU)