Since the late 1980s,basic science research in the field of stroke has elucidated multiple pathways of cellular injury and repair after cerebral ischemia, resulting in the identification of several promising targets for neuroprotection. A large number of neuroprotective agents have been shown to reduce stoke-related damage in animal models. To date, however, no single agent has achieved success in clinical trials. Nevertheless, analysis of the reasons behind the failure of recent drug trials, combined with the success of clot-lysing drugs in improving clinical outcome, has revealed new potential therapeutic opportunities and raised expectations that successful stroke treatment will be achieved in the near future. In this chapter we first highlight the major mechanisms of neuronal in-jury,emphasizing those that are promising targets for stroke therapy. We then discuss the influence of these pathways on white matter injury, and briefly review the emerging concept of the neurovascular unit. Finally, we review emerging strategies for treatment of acute ischemic stroke.
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