Management of acute ischemic stroke. An update for primary care physicians

Few areas of medicine have had as many major advances in recent years as the treatment and prevention of ischemic stroke. During the 1990s-"the decade of the brain"-carotid endarterectomy was demonstrated to be effective for preventing stroke in patients with significant carotid stenosis. Large clinical studies have documented the effectiveness of new antiplatelet agents and oral anticoagulant therapy for stroke prevention in specific patients groups, and recently tissue plasminogen activator was approved for the treatment of acute ischemic stroke. Because the use of these new therapies is restricted to specific patient subgroups, the accurate determination of the cause of stroke is now mandatory. Fortunately, advances in diagnostic methods, including cardiac and vascular ultrasonographic techniques and brain imaging, facilitate the determination of the stroke subtype in most patients. Additional advances in stroke treatment and prevention are on the immediate horizon. New therapeutic agents, including neuroprotective medications, and new treatment modalities such as cerebral angioplasty are promising investigational therapies.