Cerebroprotin in Ischemic Stroke
Cerebroprotin is not recommended for the treatment of ischemic stroke, as it is not included in any current evidence-based guidelines and lacks supporting clinical trial data demonstrating efficacy in improving mortality, functional outcomes, or quality of life.
Current Evidence-Based Treatment Standards
The established treatment paradigm for acute ischemic stroke focuses exclusively on reperfusion strategies, not neuroprotective agents like cerebroprotin 1, 2:
- Intravenous alteplase (rtPA) administered within 3-4.5 hours of symptom onset remains the cornerstone pharmacological intervention (Grade 1A for <3 hours, Grade 2C for 3-4.5 hours) 1
- Endovascular thrombectomy for large vessel occlusions within 6 hours represents the standard mechanical reperfusion approach 3, 2
- Antiplatelet therapy with aspirin 160-325 mg initiated within 48 hours for patients not receiving thrombolysis (Grade 1A) 1
Why Neuroprotective Agents Are Not Recommended
The American Heart Association/American Stroke Association guidelines explicitly state that vasodilatory agents are not recommended for treatment of acute ischemic stroke (Class III; Level of Evidence A) 3, 4. This recommendation extends to the broader category of neuroprotective agents, which have consistently failed to translate preclinical success into clinical benefit 4, 5.
The Neuroprotection Failure Pattern
Despite promising results in animal models, numerous neuroprotective candidates have failed in clinical trials 5. The reasons include:
- Time-dependent efficacy loss: Every 30-minute delay in recanalization decreases good functional outcomes by 8-14%, making neuroprotection alone insufficient 1
- Lack of reperfusion synergy: Neuroprotective strategies cannot salvage tissue without restoring blood flow 5, 6
- Translation gap: Preclinical models poorly predict human stroke heterogeneity 4, 5
Specific Guideline Positions on Experimental Agents
High-dose albumin, which underwent rigorous phase III testing (ALIAS2 Trial), showed a trend toward favorable outcomes but was ultimately not incorporated into treatment guidelines 3. The evidence for albumin remains "not well established" (Class IIb; Level of Evidence B) 3.
If albumin—with substantially more clinical trial data than cerebroprotin—cannot achieve guideline recommendation status, cerebroprotin has no evidentiary basis for use 3.
What Clinicians Should Do Instead
Focus on time-critical reperfusion therapies 1, 2:
- Immediate neurological evaluation using validated stroke scales (NIHSS) upon presentation 1
- Rapid brain imaging (CT or MRI) to exclude hemorrhage and assess vessel occlusion 1
- Blood pressure optimization to <185/110 mmHg before rtPA administration 1
- Streamlined protocols avoiding time-consuming procedures that delay definitive therapy 1
Critical Pitfalls to Avoid
- Do not substitute experimental agents like cerebroprotin for proven reperfusion therapies 4
- Do not delay rtPA or thrombectomy to administer unproven neuroprotective drugs 1
- Do not apply overly restrictive selection criteria that exclude patients who could benefit from established therapies 1
- Do not use vasodilatory agents in acute ischemic stroke outside of clinical trials 3, 4
Future Considerations
While mitochondrial-targeted therapies and other neuroprotective strategies remain areas of active research 3, they should only be administered within the context of properly designed clinical trials adhering to STAIR criteria 4. Current stroke management must prioritize rapid restoration of cerebral blood flow through proven reperfusion strategies 2, 7.
The evidence unequivocally supports reperfusion over neuroprotection as the primary therapeutic goal in acute ischemic stroke 1, 2, 6.