Neuroprotective agents in ischemic stroke: past failures and future opportunities

Tissue plasminogen activator is the only US FDA-approved therapy for acute ischemic stroke treatment. There is a need for other therapies such as neuroprotective agents that can be used in acute ischemic stroke patients. Many neuroprotective agents have been shown to be promising after testing in animal models of acute stroke, but when tested in patients, efficacy signals are not consistent or safety challenges have been noted. This review article will discuss different neuroprotective agents, including free-radical scavengers and antioxidants, NMDA-receptor antagonists, inflammatory cascade inhibitors and different ion channel blockers/modulators that have been tested in acute ischemic stroke. The review will also address the key reasons for their failure in clinical trials and provide recommendations to improve translation of basic science research into day-to-day clinical p ractice.