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Stroke. Revolution in therapy
1Department of Neurology, University of California, San Francisco, School of Medicine 94143-0114.
Insights
Stroke is a leading cause of death, but new research offers hope. Advances in stroke prevention and acute interventions, including glutamate antagonists and reperfusion therapies, are transforming emergency stroke care.
Area of Science:
- Neurology
- Emergency Medicine
- Pharmacology
Background:
- Stroke is a leading cause of death, necessitating advancements in treatment.
- Recent research has revolutionized the understanding and management of stroke.
- Primary and secondary stroke prevention strategies can avert thousands of cases annually.
Purpose of the Study:
- To review evolving strategies for acute stroke intervention.
- To highlight the role of ischemia and calcium accumulation in stroke pathology.
- To discuss promising therapeutic targets and ongoing clinical trials for stroke treatment.
Main Methods:
- Review of experimental stroke models and clinical trial data.
- Examination of the pathophysiology of ischemic stroke, including excitotoxicity and free radical formation.
- Analysis of therapeutic approaches such as glutamate antagonists, revascularization, and free radical scavengers.
Main Results:
- Glutamate antagonists show promise in experimental models, with clinical trials initiated.
- Acute revascularization techniques are feasible for restoring perfusion and minimizing infarction.
- Fibrinolytic agents demonstrate potential, and clinical studies are underway.
- Free radical scavenging agents are being tested to mitigate reperfusion injury.
Conclusions:
- Understanding ischemia and excitotoxicity is crucial for developing new stroke therapies.
- Emerging pharmacologic agents and interventions are making stroke a treatable neurologic emergency.
- Immediate intervention is critical for improving outcomes in acute stroke cases.
Abstract:
Stroke remains the third leading cause of death in this country, although recent advances in both clinical and basic science research have revolutionized the concept of stroke. Studies of primary and secondary stroke prevention have now documented the means to prevent thousands of cases of stroke each year. Three distinct strategies are evolving for intervention in the acute stroke process. Evidence is clear that ischemia leads to a toxic accumulation of intracellular calcium, in part mediated by excitatory neurotransmitters such as glutamate. Glutamate antagonists have shown clear benefit in experimental stroke models, and early clinical trials are underway. Acute revascularization to restore perfusion is also feasible and may minimize the extent of infarction. Studies of fibrinolytic agents are promising, with randomized clinical studies being done. While reperfusion is desired, it may be associated with additional neuronal injury. The development of anaerobic metabolism followed by reperfusion and aerobic conditions favors oxidation and free-radical formation. This mechanism of injury can be decreased by agents known to scavenge free radicals, and clinical trials are also testing this. This revolution in the understanding of ischemia, as well as the outpouring of new pharmacologic agents, is making stroke a true neurologic emergency requiring immediate intervention.
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