The need for new therapies for acute ischaemic stroke

Stroke creates the fourth highest burden of disease worldwide, and is the leading cause of adult long-term disability in developed countries. These factors mean that stroke has a high associated cost for healthcare systems, and a potentially devastating effect on family and carers. One of the main reasons why patients have such a poor prognosis is a lack of treatment options. Recombinant tissue plasminogen activator (rt-PA) is the only treatment currently licensed to treat selected patients with acute ischaemic stroke. However, only 1-8.5% of hospitalised patients receive treatment with rt-PA due to the short time window for administration (within 3 h of symptom onset), risk of intracerebral haemorrhage, need for a computed tomography scan, and exclusions due to other specific criteria. For acute ischaemic stroke, well-tolerated treatments that offer an extended therapeutic window are urgently needed to decrease disability, aid neurological recovery and improve patient prognosis. Neuroprotective agents potentially offer benefit to stroke patients without the associated haemorrhagic risk of thrombolytic therapy. Such agents target the ischaemic penumbra and aim to reduce the risk of brain injury and long-term disability by disrupting the cellular, biochemical, and metabolic consequences of infarction following exposure to ischaemia. Future directions should involve developing a neuroprotective compound that is safe, well tolerated and effective in a broad range of patients.