Fibrinolytic treatment of acute stroke : are we treating reversible cerebral ischemia ?

With increased understanding of the underlying pathophysiology of acute ischemic stroke, advances in imaging and interventional techniques, and the development of new fibrinolytic and neuroprotective agents, potential therapeutic options in the treatment of patients with acute ischemic stroke have became available recently (1-10). Animal studies have indicated that each minute of ischemia is harmful (11). It is generally believed that the sooner we begin to treat the brain after ischemic stroke, the better are our chances of minimizing the damage: the "time is brain" theory (National Stroke Association newsletter, 1993, 10:1). This has stimulated the drive to treat ischemic stroke as an emergency ("brain attack"). (DBO)