Introduction

Stroke occurs in over 700,000 Americans each year and is the third leading cause of death in the United States. Many survivors are left disabled, causing economic losses exceeding $30 billion annually (1).

An ischemic stroke occurs when cerebral blood flow is interrupted by a thrombus that either forms locally in the vessel or embolizes from a distant source, such as a proximal vessel or the heart. Stroke therapies might potentially reduce ischemic injury via 3 general mechanisms. The first and most obvious approach is to rapidly restore blood flow. The only currently approved medical stroke therapy, recombinant tissue plasminogen activator, is a thrombolytic that restores blood flow by recanalizing the occluded vessel (2). Thrombolytic stroke therapies are discussed in Chapter 19. The second approach involves protecting the neurons from injury during ischemia via therapies referred to as neuroprotective agents, which target the neurons in the surrounding (penumbra) region of the infarct. By slowing the activity of the neurons at various steps in the ischemic cascade, these agents can improve cell survival in the penumbra. The final approach involves limiting the effects of reperfusion injury. Even with successful blood flow return, several detrimental processes often occur that potentiate ischemic injury, including leukocyte adhesion, free radical release, and neuronal membrane breakdown (3 ). Various agents designed to target these processes are currently being studied.

In this chapter, we will review the results of clinical trials that tested the second approach— neuroprotective and antireperfusion injury agents in stroke. The mechanisms, safety concerns, and future directions for stroke treatment will also be discussed.

Your Heart and Nutrition

Your Heart and Nutrition

Prevention is better than a cure. Learn how to cherish your heart by taking the necessary means to keep it pumping healthily and steadily through your life.

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