Stratifying patients with stroke in trials that target brain repair

Abstract—A number of therapies are emerging that have the potential to reduce poststroke disability by promoting repair. Careful evaluation of patients with stroke might help distinguish those who are most likely to respond to a restorative therapy from those who lack biological substrate needed to achieve gains. Potential approaches to such stratification are considered, including measures of brain injury or of poststroke brain function. (Stroke. 2010;41[suppl 1]:S114-S116.) Key Words: stroke treatment recovery repair stratify An acute stroke initiates a number of events. Chief amongthese is brain injury, including the ischemic cascade, penumbra and its evolution, delayed neuronal loss, and apopto-sis. However, a stroke also sets into motion a series of events related to repair. Within the first few days of an infarct, the brain initiates a number of processes related to restoration of function, such as increased expression of growth-associated genes, ele-vated levels of growth factors, angiogenesis, greater endogenous neural stem cell proliferation and migration, and increased dendritic arborization and synaptogenesis.1,2 These events represent biological targets for a class o