Chapter 15 Emerging Therapies for Ischemic Stroke

Abstract

Publisher Summary This chapter discusses the clinicians and investigators with a current summary of ongoing efforts to find safer thrombolytic agents, reviews the results of important neuroprotective agents, identifies discrepancies between laboratory model studies and clinical trials, and highlights emerging concepts of acute stroke therapies. The Food and Drug Administration (FDA) approved intravenous (IV) recombinant tissue plasminogen activator (rt-PA) for acute stroke treatment in 1996. Subsequent development of mutant forms of rt-PA has changed the properties of the molecule. The most important variant or mutant form of rt-PA that has been tested in experimental stroke models, and is being tested currently in clinical trials is tenecteplase (TNK). Another thrombolytic agent that had been studied experimentally is microplasmin. Microplasmin is a truncated form of recombinant plasmin. It has been shown to improve the behavioral rating scores in a small-clot embolic stroke model in rabbits and to decrease hemorrhage in the large-clot embolic stroke model, in contrast to rt-PA, which increases the hemorrhage rate in the latter model. Intra-arterial (IA) thrombolysis remains an unapproved procedure; however, it is performed in many centers and is supported by randomized clinical trial evidence.