New aspects of calcium antagonists for treatment of cerebrovascular disease.

Cerebrovascular infarction can be subdivided into two different categories: cerebral hemorrhage and cerebral ischemia. Although the use of calcium antagonists for the treatment of subarachnoid hemorrhage has been established in many series, the benefit of these drugs for the treatment of cerebral hemorrhage is inconclusive, and we lack considerable evidence of its application in acute ischemic stroke. Inconclusive data have been reported from experimental studies using different pharmacological models and different protocols; however, various clinical studies have suggested that calcium antagonists may be useful in improving the neurological and functional outcome of the patient due to reduced infarct size and the properties of the drug to improve tissue metabolism in remote cortical territories. So far, however, these studies failed to establish the efficacy of the drug unequivocally. This may be due to the considerable amount of patients included with small or rapidly recovering neurological deficits and to the delay between onset of symptoms and start of treatment (ranging between 48 and 72 h).