The 5 Ps of acute ischemic stroke treatment: parenchyma, pipes, perfusion, penumbra, and prevention of complications

South Med J. 2003 Apr;96(4):336-42. doi: 10.1097/01.SMJ.0000063573.56033.A6.


Stroke is a treatable disease. Despite the therapeutic nihilism of the past, the advent of thrombolysis has changed the way stroke is approached. Acute ischemic stroke is a challenging and heterogeneous disease. Treatment needs to be based on an understanding of the underlying pathophysiology of ischemia. Interventions are designed to improve neuronal salvage and outcome. The underlying tenets of stroke therapy focus on the brain parenchyma, arterial flow (pipes), perfusion, the ischemic milieu or penumbra, and prevention of complications. This article focuses on the practical issues of ischemic stroke care, with a brief review of supporting literature.

Publication types

  • Review

MeSH terms

  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Aspirin / therapeutic use*
  • Heparin / therapeutic use
  • Humans
  • Stroke* / classification
  • Stroke* / drug therapy
  • Stroke* / physiopathology
  • Thrombolytic Therapy


  • Anti-Inflammatory Agents, Non-Steroidal
  • Heparin
  • Aspirin