Prophylactic pharmacologic neuroprotection against focal cerebral ischemia.

The crucial importance of the earliest possible treatment of ischemic stroke has been stressed. This leads to the concept of prophylactic neuroprotection: long-term administration of neuroprotective agents to people at risk for stroke, so that the effects of focal ischemia are countered from the moment of onset of vascular occlusion. We at NYU (and researchers at several other centers) have been testing possible neuroprotective agents in the cardiopulmonary bypass setting. We believe that by such means we can rapidly and economically screen agents and dose schedules for efficacy. We believe that an agent demonstrably reducing mental impairment after cardiopulmonary bypass suggests that testing such an agent in a prospective manner in people at risk for stroke would be productive, and we propose a sequence for such trials: people during and in the first month after carotid endarterectomy, then postcarotid endarterectomy patients during long-term follow-up, and finally populations at risk for spontaneous stroke in the nonvascular surgery setting.