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Intravenous thrombolysis before endovascular thrombectomy has become the standard treatment for acute ischemic stroke caused by anterior circulation large vessel occlusion.However,there is still controversy about direct endovascular thrombectomy or bridging intravenous thrombolysis.This article elaborates on this.
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With the widespread use of statins, they significantly reduce the risk of ischemic stroke, and are even expected to improve functional outcomes in patients with ischemic stroke. However, there are many problems to be clarified in the treatment and prevention of ischemic stroke with statins in clinical practice. This article discusses this.
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Thisarticleintroducesthedifferentperspectivesonwhetherusingcarotidendarterectomy or intensifying the optimal medical therapy alone in recurrent stroke prevention practice in patients w ith symptomatic carotid stenosis.
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Duetothepatientswithintracerebralhemorrhageusualypresenttheriskfactorsfor ischemic stroke, the survivors after intracerebral hemorrhage are usualy facing a high risk of recurrent intracerebral hemorrhage or ischemic stroke at the same time. There is alw ays controversy about w hether these patients should be treated w ith antiplatelet therapy. This article introduces the different point of view s of researchers.
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Traditionally,delayed cerebral ischemia after subarachnoid hemorrhage is caused by cerebral vasospasm.A large number of studies have been conducted for the prevention and treatment of cerebral vasospasm in order to try to improve the clinical outcomes after subarachnoid hemorrhage.However,for the treatment of cerebral vasospasm does not fundamentally reduce disability and mortality after subarachnoid hemorrhage.While researchers suspect whether the delayed cerebral ischemia is associated with cerebral vasospasm,they begin to question whether prevention of cerebral vasospasm can improve clinical outcomes after subarachnoid hemorrhage.This article analyzes this.
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Intracranial aneurysm rupture can result in life-threatening subarachnoid hemorrhage.There is no doubt about the treatment of patients with symptomatic intracranial arterial aneurysms,but whether the patients with asymptomatic intracranial aneurysms ＜ 7 mm in diameter should be treated with conservative treatment,implementation of clipping or endovascular coil embolization remain controversy.This article discusses about this.
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The efficacy of statins in the prevention of ischemic stroke has been confirmed,but whether it will increase the risk of intracerebral hemorrhage has not been determined.For patients receiving long-term statin therapy should continue or discontinue statin therapy after suffering from intracerebral hemorrhage remains controversy.This article discusses about it.
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Statin therapy has become a standard method for the prevention of ischemic stroke,and is becoming a treatment option for acute ischemic stroke.The pleiotropic effects of statins which are independent of cholesterol are the main basis of using them in the treatment of ischemic stroke.It is regarded that these pleiotropic effects may have neuroprotective effects,thus improving the neurological functional outcome of patients.At the same time,studies have shown that the therapeutic effect of statins has dose-dependent manner; therefore,we advocate using high-dose statin therapy.However,about whether high-dose statins should be used in patients with ischemic stroke of the different mechanisms remain controversial.
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There are many controversies for how to treat the occurrence of ischemic stroke on the basis of infective endocarditis would be more reasonable,especially there is no consensus on whether to treat with anticoagulants.The article discusses about this.
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Neuroimaging studies show that transient ischemic attacks of middle cerebral artery occlusion are not uncommon.Whether these patients should be treated with tissue plasminogen activator remains to be controversial.This article introduces the different views around this debate.
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With the continuous improvement of drag for stroke prevention, ipsilateral stroke risk in patients with asymptomatic carotid stenosis has been equal to or lower than that in the revascularization group in randomized controlled trials. Under this condition, is the asymptomatic severe carotid stenosis an indication for revascularization? This article introduces the views of different researchers.
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The application of recanalization devices in patients with acute iscbemic stroke has significantly increased the rate of vascular recanalization, however it does not significantly improve the outcome of patients. So, there have been controversies whether continue to restrict recanalization devices to clinical trials or direct transition to clinical practice in the absence of randomized controlled trial evidence.
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Blood pressure remains the single most important modifiable risk factor for the primary and secondary prevention of stroke. The landmark trial of the Perindoprii Protection Against Recurrent Stroke Study (PROGRESS) has suggested that the antihypertensive treatment with angiotensin-converting enzyme inhibitor (ACEI) perindopril at least 2 weeks after stroke may reduce the risks of recurrent stroke and other cardiovascular events. Although most systematic reviews have suggested that the efficacy of almost all types of antihypertensive drugs is similar in the prevention of stroke,there are also some important exceptions. The Ongoing Telmisartan Alone and in Combination with Ramipril Global End point Trial (ONTARGET) has demonstrated that the angiotensin receptor blockers (ARB) telmisartan was equivalent to ramipril for preventing cardiovascular events in patients with vascular disease or diabetes; while in a similar population,ramipril was quite effective for preventing stroke. It is speculated according to the moderating effects of ARB on the renin-angiotensin-aldosterone system that its protective effects against stroke is superior to other antihypertensives. However,many clinical trials have suggested that ARB does not have unique role in stroke prevention. Therefore,whether ARB should be regarded as the first-line drags for stroke prevention in both primary and secondary prevention settings has been controversial.
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Aspirin resistance is a common question for the preventive practice of ischemic stroke.Currently,it has not yet reached a consensus on how to manage aspirin resistance.In addition,whether to perform the detection of routine platelet function for aspirin resistance,and then whether to guide antiplatelet therapy is reasonable also have widespread cortroversy.
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There has been controversy over what method should be used to treat patients with asymptomatic carotid stenosis, especially the optimal medical therapy has been able to reduce the risk of stroke significantly in these patients and its efficacy is equal to or even exceed today's carotid endarterectomy or stenting. However, the treatment value of revascularization in patients with asymptomatic carotid stenosis does not completely disappear, and with the improved technologies and the prolonged follow-up time, their effects may be more apparent in reducing the risk of stroke. The optimal medical treatment can indeed significantly reduce the risk of stroke in patients with asymptomatic carotid stenosis, but it may not be able to solve all the problems. This article expounds the opinions of different authors in the treatment of asymptomatic carotid stenosis with revascularization according to the data available.
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How to choose and implement antithrombotic therapy has always been a controversial issue in the primary and secondary prevention of cardiac embolic stroke in patients with atrial fibrillation in clinical practice. This article synthesizes the recent literatures and discusses them.
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The evidence from epidemiological and observational studies support that homocysteine is an important risk factor for ischemic stroke. Using folic acid and vitamins B to reduce homocysteine may effectively prevent ischemic stroke. However, the results of the vast majority of clinical trials are negative. This article analyzes them.
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Cerebral venous sirras thrombosis is rare clinical practice, but there has been controversial as to whether anticoagulant therapy should be performed or not. The bone of contention is whether anticoagulant therapy is safe and effective indeed. This article discusses the above problem.
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Carotid stenosis is an important risk factor for isehemie stroke. For many years, there have been controversies surrounding how to treat carotid artery stenosis, and then effectively realize stroke prevention. This article analyzes them.
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Carotid artery and coronary atberosclcrotic lesions often coexist. How to manage the two kinds of lesions, especially to reduce the risk of perioperative stroke, whether it is necessary to treat carotid artery lesions first or simultaneously before coronary artery bypass grafting, and whether stent angioplasty can replace carotid endarterectomy in the treatment of carotid disease has been controversial. This article discusses them.