In acute ischemic stroke, abrupt vessel occlusion results in a drop in regional CBF, leading to time-dependent compartmentalization of the ischemic brain into tissue that is irreversibly damaged (ischemic core), tissue that is functionally impaired but structurally intact and thus potentially salvageable (penumbra), and tissue that is hypoperfused but not threatened under normal circumstances (oligemic brain). At a cellular level, neuronal damage occurs through a complex interaction of mechanisms (necrosis, apoptosis, excitotoxicity, inflammation, peri-infarct depolarization, acidosis, and free radical formation) that are characteristic for each compartment. All these mechanisms are potential targets for neuroprotective therapy, which, combined with flow restoration strategies, is likely to improve outcome significantly in human stroke.
Relationship Disclosure: Dr Jovin has received personal compensation for activities with CoAxia and Concentric Medical, Inc. Dr Jovin has received personal compensation as associate editor of Journal of Neuroimaging. Dr Demchuk has received personal compensation for activities with AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., and sanofi-aventis. Dr Demchuk has received grant support from Novo Nordisk, Inc. Dr Gupta has received personal compensation for activities with Concentric Medical, Inc.
Unlabeled Use of Products/Investigational Use Disclosure: Drs Jovin and Gupta have nothing to disclose. Dr Demchuk discusses the unlabeled use of emerging therapies with numerous references to potential therapies.