New Perspectives in Neuroprotection for Ischemic Stroke

[Display omitted] •Improvements in stroke care have opened up opportunities to study new protective therapies.•Recanalization therapies, new imaging techniques and biomarkers have improved their efficacy.•Combination of protective drugs after successful reperfusion appears to be crucial.•Future directions must find a way to extend the use of protective drugs beyond recanalization.•Protection as early as possible in the pre-hospital setting seems to be the ideal. The constant failure of new neuroprotective therapies for ischemic stroke has partially halted the search for new therapies in recent years, mainly because of the high investment risk required to develop a new treatment for a complex pathology, such as stroke, with a narrow intervention window and associated comorbidities. However, owing to recent progress in understanding the stroke pathophysiology, improvement in patient care in stroke units, development of new imaging techniques, search for new biomarkers for early diagnosis, and increasingly widespread use of mechanical recanalization therapies, new opportunities have opened for the study of neuroprotection. This review summarizes the main protective agents currently in use, some of which are already in the clinical evaluation phase. It also includes an analysis of how recanalization therapies, new imaging techniques, and biomarkers have improved their efficacy.