Therapeutic Strategies in Cerebral Ischemia

Despite many recent innovations in therapy, stroke remains one of the greatest challenges in modern medicine, primarily because so few of these new treatments have proved effective. To date, systemic thrombolysis with intravenous tissue plasminogen activator (t-PA) remains the only proven treatment to improve clinical outcomes of patients with acute ischemic stroke. This book reflects on those aspects of these therapies that currently pose potentially formidable challenges to effective treatment or, alternatively, that offer tremendous opportunities for the future. A discussion of arterial revascularization is complemented with coverage of collateral perfusion and the role of the venous system. Fundamentals of supportive care such as hemodynamics and oxygen administration are followed by a reconsideration of neuroprotection in general. The challenges of minor stroke and transient ischemic attacks are considered and hemorrhagic transformation associated with more severe ischemia is also detailed. The importance of early preventive strategies during the subacute phase is also emphasised. Finally, the continuum from animal to clinical research is placed in perspective with a consideration of translational approaches and the use of vascular endpoints in the clinical setting. Each challenge or potential hurdle to advancing therapy of cerebral ischemia presents an opportunity for innovation. This volume not only provides a scholarly review of current interventions, their dvantages and shortcomings, but offers important insights into the likely direction of future therapeutic strategies and their targets.