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(Stroke. 2008;39:1659.)
© 2008 American Heart Association, Inc.

Editorials

Is It Time to Definitely Abandon Neuroprotection in Acute Ischemic Stroke?

Maria Luisa Sacchetti, PhD, MD

From the Department of Neurological Sciences, La Sapienza University of Rome, V. le dell’Università, Rome, Italy.

Correspondence to Maria Luisa Sacchetti, Department of Neurological Sciences, La Sapienza University of Rome, V. le dell’Università, 30 00185 Rome Italy. E-mail marialuisa.sacchetti@uniroma1.it

Key Words: acute care • neuroprotection • thrombolysis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related article, pages 1751–1758.

Since the ischemic penumbra was discovered and since a therapeutic window for acute ischemic stroke has been postulated, stroke experts are looking for safe and effective drugs to treat as many acute ischemic stroke patients as possible.

Maturation of ischemic damage is a complex process, triggered by hypoperfusion at critical levels and spontaneously evolving toward cell death. It is a self-perpetuating process in which some critical steps (such as ion pumps failure and iNOS production) maintain and enhance the process.¹

Reperfusion may reverse the ischemic cascade but, at the same time, induces a further damage. The risk/benefit ratio of reperfusion depends on the amount of penumbral salvageable tissue, that is "individual" and only partially predictable.^2,3 Spontaneous reperfusion may occur, and symptoms may reverse, partially or totally, but the percentages of spontaneous reperfusion so far reported account for approximately the 24% of all stroke cases.⁴ A review of published articles about cerebral angiography in stroke reported that the percentage of spontaneous reperfusion on a population of major strokes observed within 6 to 8 hours of onset is approximately 17% of patients.⁵

Pharmacological reperfusion is effective and recommended in selected cases.⁶ This population represents a minority of all hospitalized acute ischemic strokes; the majority of patients are excluded from the treatment because they present at the hospital over the 3-hour time window^7–10. In this issue of Stroke, in the SAINT I and II trials pooled analysis, only 418 of 5080 acute ischemic stroke patients . . . [Full Text of this Article]

Related Article:

NXY-059 for the Treatment of Acute Stroke: Pooled Analysis of the SAINT I and II Trials

Hans-Christoph Diener, Kennedy R. Lees, Patrick Lyden, Jim Grotta, Antoni Davalos, Stephen M. Davis, Ashfaq Shuaib, Tim Ashwood, Warren Wasiewski, Vivian Alderfer, Hans-Goran Hårdemark, Larry Rodichok for the SAINT I and II Investigators
Stroke 2008 39: 1751-1758. [Abstract] [Full Text] [PDF]