Cerebral Infarction with Diffuse and Severe Atherosclerosis of The Main Cerebral Artery and Recurrent Infarction Despite Multiple Antiplatelet Agents: Management for Acute Stroke Patients

Abstract

The recent approval of prasugrel will expand the choice of medical treatment. Prasugrel, as a platelet inhibitor, was approved for the management of cardiovascular events (including stent thrombosis) in patients with acute coronary syndrome in 2009. In 2021, it was also approved for use in patients with ischemic stroke. However, there have been cases of patients showing resistance to medical treatment and, therefore, worsening symptoms. It is important to approach treatment while considering the next step. Physicians should be aware of medical treatment choices, including the use of antiplatelet drugs, as well as the appropriate timing to shift to surgical treatment when necessary. In this paper, clinical practice options and guidelines will be considered.