Excerpt
Acute ischemic stroke (AIS) is a disease of heterogeneity [
1]. In patients with strokes of known causes, cardioembolic stroke is the predominant subtype making up 29% of the population, whereas both atheroembolic and lacunar strokes are represented by 16% of the population [
2,
3]. Most stroke victims having multiple prevailing conditions prior to the onset of the devastating vascular event, such as hypertension or diabetes [
1,
4]. Based upon the patient population enrolled in a few prominent clinical trials, it is estimated that 80–90% of all stroke patients were medicated with a variety of pharmaceuticals including antihypertensives (i.e., β-blockers), angiotensin-converting enzyme (ACE) inhibitors, diuretics, calcium channel antagonists, 3-hydroxy-3-methylglutaryl-coenzymeA (HMG-CoA) reductase inhibitors (i.e., statins), platelet inhibitors (i.e., aspirin, clopidogrel), anticoagulants (i.e., warfarin), and antidepressants at the time of their stroke [
1,
4‐
8]. Despite many preventative measures to reduce stroke incidence, stroke remains the third leading cause of death and leading cause of adult disability in the USA [
9]. It is estimated that approximately 0.8 million victims suffer a stroke annually with 18% of victims dying. Even though there is a large population of stroke victims in the USA [
9‐
12] and worldwide [
13], and there is an enormous financial impact and burden to society [
14], the arsenal of armaments to effectively treat stroke is limited to one thrombolytic agent that was originally developed to treat acute myocardial infarction [
15‐
20] and subsequently approved for stroke on the basis of the National Institute of Neurological Disorders and Stroke (NINDS) trial [
1]. However, it should be noted that in addition to the use of tissue plasminogen activator (tPA) in Japan, a single non-thrombolytic drug, which will be discussed, is also formally approved as a treatment [
21]. …
