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Past, Present, and Future

Marc Fisher, MD; Wolf Schaebitz, MD

Arch Intern Med. 2000;160:3196-3206.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

The effort to develop effective therapies for acute ischemic stroke achieved several important successes during the past decade, but also many disappointing failures. The 2 primary successes were related to thrombolysis. The first was the NINDS rt-PA (National Institute of Neurological Disorders and Stroke Recombinant Tissue-Type Plasminogen Activator) trial reported in 1995. This study demonstrated that initiation of intravenous (IV) rt-PA within 3 hours after the onset of acute ischemic stroke significantly improved outcome at 3 months.¹ This study led to the approval of rt-PA initiated within 3 hours of stroke onset as the only currently available acute stroke therapy. The second major success was the demonstration that intra-arterial prourokinase initiated within 6 hours of stroke onset in patients with angiographically documented proximal middle cerebral artery (MCA) occlusion also improved outcome at 3 months.² A third marginally positive acute stroke trial used ancrod, a . . . [Full Text of this Article]

THROMBOLYTIC THERAPY FOR ACUTE ISCHEMIC STROKE

PATHOPHYSIOLOGICAL TARGETS FOR NEUROPROTECTION

ACUTE TREATMENT STRATEGIES

Calcium Antagonists

NMDA-Antagonists

AMPA-Antagonists

-Aminobutyric Agonists

Lubeluzole

Free Radical Scavengers

Antibodies to Intercellular Adhesion Molecules

Inhibition of Cytokines

Statins

RECOVERY TREATMENT

Growth Factors

Citicoline

Nootropic Agents

Combination Treatment

CONCLUSIONS

SUMMARY

From the Departments of Neurology, University of Massachusetts Medical School, Worcester (Dr Fisher), and University of Heidelberg, Heidelberg, Germany (Dr Schaebitz). Dr Fisher serves as a paid consultant to Bristol-Myers Squibb.

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