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Antithrombotic therapy for prevention and treatment of ischemic stroke
1Neurology and Neurological Sciences, Stanford University Medical Center, Palo Alto, California, USA.
Insights
Atherosclerosis and cardiac issues like atrial fibrillation are leading causes of ischemic stroke. Effective prevention and treatment depend on understanding the diverse causes of stroke.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Background:
- Ischemic stroke is a major cause of disability and death.
- Atherosclerosis of cervical and intracranial vessels, and the aorta, is the primary cause.
- Lacunar strokes from small penetrating artery lesions and emboli from cardiac sources (e.g., atrial fibrillation) constitute significant proportions of ischemic strokes.
Purpose of the Study:
- To highlight the diverse etiologies of ischemic stroke.
- To underscore the challenges in selecting appropriate antithrombotic and thrombolytic therapies based on stroke cause.
Main Methods:
- Review of existing literature on ischemic stroke causes.
- Analysis of the contribution of different etiological factors to stroke incidence.
Main Results:
- Cervical, intracranial, and aortic atherosclerosis are the most common causes of ischemic stroke.
- Small penetrating artery occlusive disease causes approximately 20% of ischemic strokes (lacunar strokes).
- Cardiac emboli, notably from atrial fibrillation, account for about 25% of ischemic strokes.
Conclusions:
- The varied etiologies of ischemic stroke complicate prevention and treatment strategies.
- Tailoring antithrombotic and thrombolytic therapies to specific etiological factors is crucial for effective management.
Abstract:
Atherosclerosis involving the cervical vessels, intracranial vessels, or the aorta is the most common cause of ischemic stroke. Occlusive lesions of small penetrating brain arteries cause small "lacunar" strokes, which account for about 20% of ischemic strokes. Emboli from a variety of cardiac sources, particularly atrial fibrillation, account for about 25%. Efforts to prevent and treat ischemic stroke are complicated by the variety of etiologies underlying it and the selection of antithrombotic or thrombolytic therapy appropriate to the particular etiology.