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Neuroprotective Stroke Trials: A Ten Year Dry Season

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Cerebral Blood Flow

Part of the book series: Update in Intensive Care Medicine ((UICMSOFT,volume 37))

Abstract

For stroke patients presenting within 3 hours of a significant hemispheric ischemic stroke, thrombolysis induced by the administration of exogenous tPA will reduce death and disability [1]. For every thousand stroke patients treated, an additional 160 will recover to an independent status within three months. The data for patients treated between three and six hours suggests there may be a signal of efficacy but neither the clinical trials [2] nor the meta-analysis has yet to give us a robust answer [3]. The fact that patients benefit within three hours, but not between three and six, is not because of an excess of hemorrhages in the three to six hour group [3], but because of a lack of cell recovery following brain resuscitation with delayed reperfusion. Simply stated the reperfusion is too late. While the best neuroprotectant will always be the rapid return of oxygen and glucose, the fact that attempts to restore circulation within the first three hours are highly effective confirms the concept that reperfusion will salvage brain tissue. A successful neuroprotectant must either increase the time window to allow more patients to be effectively reperfused, perhaps up to six hours, or reduce the injury sustained during ischemia. In the event that reperfusion is injurious, it must reduce not only the initial reperfusion injury but also sustain cells which are left ailing in the hours and days that follow successful reperfusion.

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  1. Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada

    Alastair M. Buchan MD (Professor of Neurology)

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© 2003 Kluwer Academic/Plenum Publishers, New York

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Buchan, A.M. (2003). Neuroprotective Stroke Trials: A Ten Year Dry Season. In: Cerebral Blood Flow. Update in Intensive Care Medicine, vol 37. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-56036-1_18

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  • DOI: https://doi.org/10.1007/978-3-642-56036-1_18

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-42684-4

  • Online ISBN: 978-3-642-56036-1

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