Stroke research has been the subject of increased attention in recent years. As a result, significant progress has been made in the understanding of the mechanisms of ischemic injury and development of potential methods of treatment. Unfortunately, only one therapy has been shown to be of benefit for acute ischemic stroke patients in a randomized controlled clinical trial: intravenous administration of recombinant tissue plasminogen activator (rt-PA) (The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (NINDS), 1995). Clinical and basic scientists have been contemplating the reasons for the failure to translate a large number of potential treatments into clinical practice. There are a number of possible explanations that include heterogeneity of human disease, and inherent species-related differences. In contrast to animal models where subjects have similar genetic material and undergo identical procedures, human stroke patients vary in their co-morbidities, age, risk factors, type and location of stroke, duration and severity of ischemia, among other things. Interestingly, the factors that contribute to the heterogeneity of human stroke play a significant role in the reversibility of ischemic injury (Table 5.1). We will discuss in this chapter some of the aspects that are associated with the ability of the brain tissue to improve its function following ischemia as it is seen in clinical practice.
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