Prophylactic treatment

The aim of neuroprotective maneuvers is to influence the ischemic cascade so as to maximize the proportions of ischemic volume that will survive and recover. Results of clinical as well as experimental studies have stressed the earliest possible treatment of ischemic stroke and led to the concept of prophylactic neuroprotection. The duration of prophylactic neuroprotection depends upon the conditions of the patients. Patients undergoing procedures such as cardiac surgery, endarterectomy, or endovascular therapy, which have a risk of cerebral ischemic events during a defined period, might be considered for short-term, periprocedure prophylactic neuroprotection. In addition high risk populations suffering from transient ischemic attacks and atrial fibrillation as well as those at risk for stroke recurrence after minor strokes are readily identifiable and perhaps appropriate for longterm prophylactic neuroprotection. Patients with hypertension and cerebrovascular atherosclerosis have a high stroke risk and therapies directed at these underlying disorders are available that also have concomitant neuroprotective effects (10, 39, 40). If a neuroprotective drug is available orally, safe and relatively inexpensive, it could be considered for prophylactic use in people at risk for stroke and could be used to counter the biochemical changes as a result of vascular occlusion thereby preventing the extent of neuronal injury.

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