New treatments for cerebrovascular disease

Management of cerebrovascular disease involves medical and surgical therapies. Medical management, including antiplatelet therapy and statin therapy, has been mainstay treatment for the prevention of this disabling problem. Several studies have shown improved outcome in the prevention of stroke in patients who are taking these medications. Surgical management has also firmly established itself as an important modality in treating this disease. Several prospective, randomized trials have defined the patients that would have the most benefit from carotid endarterectomy. These include asymptomatic patients with a stenosis of 60% stenosis or more and symptomatic patients with a stenosis of 50% or more. The timing of carotid endarterectomy after stroke remains controversial, but recent studies advocate early carotid endarterectomy in a select group of patients. During the carotid endarterectomy, the method of closing of the arteriotomy has an overall effect on the safety of the procedure and on long-term outcome. Compared with primary repair of the arteriotomy, patch closure has been shown to decrease the frequency of restenosis. In addition, carotid eversion endarterectomy is an alternative method to remove the plaque and has an efficacy similar to standard carotid endarterectomy. The role of carotid angioplasty and stenting, which offers the patient a less invasive method of treating the carotid plaque, continues to evolve.