Stroke Neuroprotection May Have Been Running the Wrong Race

Key Takeaway

A critical review of recent phase III stroke trials finds a clear split. Brain-protecting drugs given within 24 hours, mostly alongside clot-removing treatment, largely showed no benefit, while those started between 24 hours and 14 days later, often in patients whose blocked artery was never reopened, showed clear treatment effects. If the pattern holds, these drugs may work by helping the brain heal over days, not by rescuing dying tissue in the first frantic hours.

The Race Against the Clock That May Have Been the Wrong Race

Picture a 68-year-old woman wheeled into the emergency department 2 hours after her left arm went limp. The stroke team moves with practiced urgency, because every neurologist has learned the same mantra: time is brain. A large stroke can destroy nearly 2 million nerve cells every minute. Within an hour, she receives a clot-dissolving drug, and a catheter pulls the clot from her brain artery. The vessel opens. Then, on top of all that, she might be enrolled in a trial of a “neuroprotective” drug meant to shield…