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Strategies for therapy in acute ischemic stroke

Nature Clinical Practice Neurology volume 3, pages 2–3 (2007)Cite this article

In order to maximize the chances of a good outcome after acute ischemic stroke, strategies to improve the perfusion of viable brain tissue must be set against treatment risks, namely intracerebral hemorrhage. The past decade has seen repeated struggles to build on the success of the pivotal National Institute of Neurological Disorders and Stroke trial,1 largely because of this difficult balance between benefits and risks of therapy. This article seeks to describe these treatment strategies and to highlight the most likely ways in which the right treatment for the right patient will be chosen in the future.

The pathophysiology of acute ischemic stroke has been identified using PET, which revealed two patterns of tissue response to cerebral ischemia. At the core of the affected area is densely ischemic tissue destined to infarct, with low blood flow, failure of metabolism and subsequent failure of oxygen extraction. The core is surrounded by the penumbra, the metabolism of which is maintained because of the tissue's ability to extract oxygen efficiently, despite significant reductions in blood flow. This misery perfusion will, however, collapse with recruitment to the core if the tissue is not reperfused or supported by increased collateral flow.2 Two broad strategies for treatment emerge: first, limiting infarct size either by directly returning the blood supply to the penumbra or by improving its collateral supply; and second, protecting tissue at risk to buy time while the blood supply is returned.

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Authors and Affiliations

  1. AM Buchan is Professor of Clinical Geratology and head of the Acute Stroke Programme, and J Kennedy is Senior Lecturer in Geratology and Stroke Medicine, at the University of Oxford, Oxford, UK.,

    Alastair M Buchan & James Kennedy

Authors
  1. Alastair M Buchan
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  2. James Kennedy
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Correspondence to Alastair M Buchan.

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Competing interests

Alastair Buchan is funded by a Medical Research Council Strategic Development Award. James Kennedy declared he has no competing interests.

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Buchan, A., Kennedy, J. Strategies for therapy in acute ischemic stroke. Nat Rev Neurol 3, 2–3 (2007). https://doi.org/10.1038/ncpneuro0393

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