Difficulties and prospects of rational therapy of ischemic strokes

Abstract

Despite significant progress in medical technology, many topical issues in neurology remain unresolved; among the latter, acute cerebrovascular accidents (strokes) continue to be one of the most important medical and social problems of the modern world, since their rates of morbidity, mortality and disability are steadily growing. The increase in the incidence of strokes over the past 30 years by 70% reflects the imperfection of modern medical strategies for the primary prevention of stroke and measures for their implementation among the population, which dictates the need to revise the prevailing ideas about the etiology, pathogenetic mechanisms and therapeutic approaches to managing patients with cerebrovascular pathology. The article presents a classification of strokes, a critical analysis of vascular risk factors (in particular, the emergence of new ones, such as acute coronavirus infection COVID-19), fundamental elements of the ischemic cascade, pathomorphological and pathophysiological consequences of ischemic damage to the central nervous system (necrosis and apoptosis of neurons, diaschisis in the penumbra zone), current theoretical (targets of drug exposure) and practical (therapeutic window) aspects of therapy and prevention of acute cerebrovascular accidents are outlined. The place and importance of the use of neuroprotective drugs in the combined therapy of patients with acute and chronic cerebrovascular pathology has been demonstrated. Particular attention is focused on neurometabolic drugs with a multimodal mechanism of action, which not only protect the neuronal cytoskeleton, but also increase the tolerance of brain tissue to hypoxia.