Chapter 2 - Advances in the Acute Treatment and Secondary Prevention of Stroke

Abstract

This chapter focuses on the development of several recent advances in acute stroke treatment and secondary stroke prevention. The ability to effectively treat a patient having an acute stroke and reverse neurological deficit can be dramatic and rewarding. This chapter reviews clinical trials of thrombolytic therapy for stroke and clinical trial methodology that led to the success of the National Institutes of Neurologic Disorders and Stroke (NINDS) IV tPA trial. The use of IV tPA has empowered physicians when they encounter eligible stroke patients. To expand treatment abilities, many avenues remain open for exploration including neuroimaging— for patient selection, neurointerventional techniques, and neuro protectants. To diminish stroke risk, aggressive control of traditional risk factors continues to be the key element and it is in the treatment of these risk factors that elucidates some of the mechanisms underlying cerebrovascular disease, such as inflammation. This chapter further illustrates mechanisms that allow traditional therapies, such as antihypertensives and cholesterol-lowering agents to provide additional vascular protective effects. This can lead to the development of more effective pharmacological agents. It is noted that continued clinical investigations is needed in treating and preventing stroke and its long-term effects.