Treatment of acute ischemic stroke: selecting the right treatment for the right patient

At present, thrombolytic therapy is the only therapy approved for the treatment of acute brain injury among patients with ischemic stroke. While recombinant tissue plasminogen activator (rt-PA) is efficacious, its usefulness is limited, largely because of the very limited time window for its administration. Other medications that have potential neuroprotective actions or that affect coagulation or flow have not been established as efficacious or have not been approved by regulatory authorities. Additional therapies are needed to reduce the neurological consequences of ischemic stroke. Although the number of options to treat the stroke itself is limited, physicians should remember that management is multifaceted. Even if a patient cannot be treated with rt-PA, there is much that can be done to improve outcomes. Therapies of proven value are available to prevent or control complications, to augment recovery and to forestall recurrent stroke. The choice of treatment will continue to be made on a case-by-case basis and will be influenced by a number of variables. The most important factors are the time interval from stroke, the severity of the neurological impairments, the results of the baseline brain imaging and the cause of stroke.