The last decade has witnessed a number of major developments in the field
of stroke. A major breakthrough in the treatment of ischemic stroke was attained by the
demonstration of improved functional outcomes with intravenous tissue plasminogen
activator therapy in the hyperacute period. Recent efforts of pre-hospital thrombolysis
facilitated by the use of specialized stroke ambulance systems and newer generation
thrombolytics provide promising results in terms of optimizing the benefit obtained
from intravenous thrombolysis. These advances, together with successful results
observed by endovascular recanalization, especially by the use of thrombectomy
devices, unambiguously demonstrate that the penumbra concept (presence of a
salvageable ischemic brain tissue) is valid. Despite these encouraging developments,
other approaches like neuro-glial protection or restoration have not been so successful
in patients with acute ischemic stroke. Nonetheless, there is still hope for these
therapies, especially if clinical and radiological algorithms are developed for
appropriate patient selection and the recanalization is supplemented by measures
aiming neuroprotection and restoration of blood flow not only at the arterial but also
microcirculatory level. As for secondary prophylaxis of ischemic stroke, the
availability of new anti-platelet and anti-coagulant agents combined with the progress
attained in risk factor control has led to an impressively significant reduction in stroke
related mortality and morbidity over the last decades.
Keywords: Anticoagulants, Antiplatelet agents, Drug treatment, Endovascular
recanalization, Ischemic stroke, Microcirculation, Neuroprotection, Penumbra, Thrombolytics.
