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KMID : 1225120110030010013
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Vascular Neurology
2011 Volume.3 No. 1 p.13 ~ p.19
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Past and Future for Therapeutic Paradigm in Stroke
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Kim Hyun-Woo
Cho Kyoung-Joo
Kim Gyung-Whan
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Abstract
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Stroke is one of the largest causes of death in the world. Although medicine has had remarkable progress, therapy for the stroke is weakly understood. Just the recombinant tissue plasminogen activator ia an approved medical therapy by American Heart Association guideline, however, only 1-3% of stroke patients are receiving the treatment because of its limited 3 hour time window, about 50% recanalization and grate risk of hemorrhage. Many clinical trials are required for the acute stroke patients, who can not be applied reperfusion therapy, although molecular mechanisms and skills for saving acute ischemic stroke have been studied and developed. In this review, we introduce pathophysiology and ischemic penumbra, and discuss therapeutic target for ischemic penumbra. Next, we overview the molecular mechanism and current issuesfor acute ischemic stroke treatment. Lastly, we will discuss why late reperfusion is ineffectual medical therapy for patients who are treated after 3 hours ofstroke onset although many clinical trials have been done. Taken together,we suggest that new paradigm fortreatment of acute ischemic stroke isfocused on saving the ischemic penumbra, widen the therapeutic window, and repairing damaged neuron.
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KEYWORD
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Ischemic stroke, Recombinant tissue plasminogen activator (rtPA), Reperfusion therapy, Time window, DNA repair
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