Neuroprotectives in acute ischemic stroke, hope or hype?

ABSTRACT

Stroke is a significant public health burden which absolutely requires more effective therapies. The approved treatment options for stroke including tissue plasminogen activators, antiplatelet agents and anticoagulants mainly bear antithrombotic effects. Meanwhile, evolving investigational approaches such as collateral therapeutics and neuroprotective agents has thus far been attempted with equivocal effects on stroke outcome. The basic structural and ultrastructural changes following acute ischemic stroke should be well-considered when trying to target oxidative stress and cell death pathways using neuroprotective agents. Clearly, the positive results of preclinical studies on neuroprotectives and collateral therapeutics in stroke do not necessarily translate to the true clinical benefits of these agents. As such, several large advance-phased trials have already failed to prove so. On the other hand, controversial results in clinical setting should not discourage further research endeavors on the same. Besides, the concurrent use of flow augmentation and neuroprotectives may serve further clinical benefits. Based on the available evidence, it appears that optimization of preclinical studies and further well-designed prospective clinical trials let neuroprotection possibly find its position in stroke management. The present paper discusses key preclinical and clinical studies on neuroprotectives towards improved outcome in acute ischemic stroke