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Updated: Apr 10, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Pharmacological therapy of acute ischaemic stroke: Achievements and problems
Antonio Moretti1, Federica Ferrari1, Roberto F Villa1
1Laboratory of Pharmacology and Molecular Medicine of Central Nervous System, Department of Biology and Biotechnology, University of Pavia, Italy.
Insights
Acute ischaemic stroke (AIS) treatment focuses on restoring blood flow to salvage brain tissue. Current strategies like thrombolysis are limited, necessitating research into new therapies and cost-effective approaches for this growing global health issue.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Pharmacology
Background:
- Acute ischaemic stroke (AIS) is a major cause of death and disability globally, with increasing incidence and costs due to an aging population.
- AIS results from blocked brain blood vessels, creating an irreversibly damaged core and a potentially salvageable penumbra.
- Prompt restoration of blood flow to the penumbra is crucial for patient recovery.
Purpose of the Study:
- To review the current status of pharmacological therapies for AIS.
- To analyze the challenges, future perspectives, and cost-effectiveness of AIS treatments.
- To discuss the limitations of existing treatments and ongoing research.
Main Methods:
- Literature review of current and emerging pharmacological treatments for AIS.
- Analysis of treatment guidelines, clinical trial data, and cost-effectiveness studies.
- Examination of acute complications such as hypertension and hyperglycemia in AIS patients.
Main Results:
- Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) is the standard but is underutilized due to exclusion criteria.
- Investigational thrombolytics and endovascular therapies are being explored, though definitive evidence for the latter is pending.
- Management of hypertension and hyperglycemia are critical components of acute AIS care.
Conclusions:
- There is a need for improved and more accessible pharmacological treatments for AIS.
- Further research is required to establish the efficacy and cost-effectiveness of novel therapeutic strategies.
- Optimizing current treatments and managing comorbidities are essential for improving outcomes in AIS.
Abstract:
Acute ischaemic stroke (AIS) is a leading cause of death and disability worldwide. Its incidence and prevalence increase considerably with age and numbers will grow with an ageing population. Consequently, the impact of AIS on costs is soaring. AIS is caused by the abrupt occlusion of an intracranial vessel resulting in reduced blood flow to the brain region supplied. The ischaemic core (which is irreversibly lesioned) is surrounded by the penumbra region with less severe flow reduction, lower functional impairment and potential recovery. Therefore, the fundamental treatment of AIS relies on prompt recanalisation and reperfusion of the threatened, but potentially salvageable, ischaemic penumbra. With this aim, intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) remains the current strategy. However, thrombolysis is underused, owing to various exclusion criteria that limit the number of treated patients. Other thrombolytics are under investigation. Endovascular therapy with mechanical recanalisation devices is also increasingly applied, though definite evidence of its benefit is lacking. Moreover, hypertension and hyperglycaemia are acute complications to be treated in AIS. This review analyses the current status, the problems, the perspectives and the cost-effectiveness of the pharmacological therapy for AIS.
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