A potentially enormous market without therapeutic options is attracting a lot of new technology developesr and venture capital to stroke. But the opportunity for clot-busting approaches is limited and getting enough patients for clinical trials is tough. In a market full of unknowns, one thing is certain: the ultimate goal of any stroke therapy is to avoid neurological deficit.

The field of acute ischemic stroke is highly promising but enormously risky and fraught with disappointment. With the exception of tPA, no one has ever demonstrated a pharmaco-mechanism which produces efficacy in the clinic. For now, the key to success for companies will be good efficacy and safety data. Start-ups will need partners, but even alliances with major pharmaceutical companies don’t represent a short-term validation of their efforts, since even big companies are stumbling in this field.