Future advances in the treatment of acute ischemic stroke

The main obstacles to the use of tissue plasminogen activator in acute ischemic stroke are its narrow therapeutic window of 3 h and the possibility of symptomatic intracranial hemorrhage. Hence, current research is directed towards extending the therapeutic window whilst minimizing this complication. This review summarizes different approaches and gives a brief overview of the current concepts that are important in order to overcome these limitations. The main issues discussed include the concept of ischemic penumbra and its salvage by means of improving patient selection based on penumbral imaging, reperfusion and neuroprotection. We provide a perspective into how current acute stroke research may shape future acute stroke therapy.