Translational Stroke Research Opportunities and a Strategy to Develop Effective Cytoprotection

Excerpt

The recent success of endovascular procedures alone or accompanied by thrombolysis has provided stroke victims with a form of therapy that can be used in a population of stroke victims with large vessel occlusions (see [1‐6]. And (MR. CLEAN) [7], Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) [8], Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours (REVASCAT) [9], Solitaire With the Intention For Thrombectomy as PRIMary Endovascular Treatment (SWIFT PRIME) Trial [10] and Extending the Time for Thrombolysis in Emergency Neurological Deficits-Intra-Arterial (EXTEND-IA) [11]). The immediate goal of the stroke community is to continue to develop novel forms of cytoprotective therapy to further enhance the benefit of embolectomy and thrombolysis [12‐14]. By demonstrating additional clinical benefit with a cytoprotective compound in standardized translational stroke models, we may be able to initiate clinical trials in patients undergoing thrombolytic/endovascular procedures [12, 15]. However, the development of neuroprotective compounds has been fraught with problems, in particular, the lack of efficacy in many stroke clinical trials. There are many reasons for this failure, and they have been reviewed in detail elsewhere [12, 16‐18]. …