Current patterns and future possibilities in the care of acute ischemic stroke

Zack Hall, Director of the NINDS, succinctly described the present situation: "This is the golden age of neuroscience research" (verbal presentation at the annual meeting of the American Neurological Association, 1997). Recent trials in clinical research have demonstrated the power of thrombolytic therapy in acute ischemic stroke, and investigators across the country are now refining that therapy. The advantages of thrombolytic intervention can be provided to a much larger proportion of the population as we defined techniques to slow the rate of neuronal cell death after ischemia. However, the most exciting future opportunities for care of individuals of acute ischemic stroke arises from two somewhat unsuspected avenues. First, neuroscientists are learning in an extraordinarily rapid fashion the potentials of replacement of neural cell populations using progenitor cells. Second, the incredible explosion of genetic information has created an opportunity to identify genes responsible for atherosclerosis and other cerebrovascular disease. This, in turn, could lead to precise therapies that prevent or diminish the disease. Exploiting these opportunities requires that neural clinicians continue their cooperative efforts and, also, learn to work together with neuroscientists and geneticists. With such cooperation, we are poised to translate the golden age of neuroscience research into a genuine benefit for individuals with cerebrovascular disorders.