Neuroprotectants

Despite rapid and recent progress in our understanding of numerous new mechanisms regulating neuronal cell physiology and responses to ischemia, no neuroprotective agents have been developed as an adjunctive treatment for acute ischemic stroke. However, with the widespread deployment of acute tissue perfusion-based stroke imaging and endovascular thrombectomy, there is a great therapeutic opportunity to identify patients with salvageable ischemic tissue and provide neuroprotective treatment along with recanalization that significantly improves stroke outcome. In this chapter, we review seminal and recent developments in our understanding of the mechanisms underlying ischemic large vessel stroke injury including bioenergetic failure, excitotoxicity, oxidative stress, regulated cell death, and inflammation. Exciting developments in collaborative translational research efforts will provide investigators with a blueprint for systematically testing the most promising therapies preclinically analogous to clinical trials. Together, these basic, translational, and clinical advances hold the promise of developing novel neuroprotective therapies and greatly improving stroke patient outcomes.