Cause Of Acute Ischemic Stroke Research Articles

Imaging Acute Stroke is Rapidly Evolving

With theadventof advancedMRandCT techniques and new endovascular procedures, diagnosis and management of acute stroke are a rapidly evolving field. It would be impossible to cover all the important aspects of acute stroke in a single edition of Neuroimaging Clinics of North America, and I have focused on selected topics. Since atheromatous disease is a major cause of acute ischemic stroke, one article includes a review of noninvasive imaging of the carotid artery with a focus on vulnerable plaque imaging. Five articles address advanced CT and MR techniques such as CTA, CT perfusion, diffusionweighted imaging,diffusion tensor imaging,dynamic susceptibility perfusion-weighted imaging, arterial spin labeling perfusion-weighted imaging, and permeability imaging for evaluating acute ischemic stroke. Three articles address intravenous and intraarterial therapies and the use of advanced imaging to guide patient selection. One reviews intraarterial recanalization strategies. One addresses the role of diffusion and perfusion MRI in selecting patients for IV therapy and reviews major trials to date. An additional article reviews ASPECTS and other neuroimaging scores that are used in the acute setting to guide patient selection for intravenous and intra-arterial therapies and to help predict outcome.

Aspirin or Anticoagulation to Prevent Stroke in Carotid Dissection

Spontaneous extracranial internal carotid artery dissection is an uncommon cause of acute ischemic stroke. Treatment is aimed at prevention of

Acute Ischemic Coronary Artery Disease and Ischemic Stroke: Similarities and Differences

Although acute myocardial infarction (MI) and acute ischemic stroke share similarities, physicians need to recognize important differences in pathophysiology and how these differences affect acute treatment and prevention to provide optimal patient care. Potential causes of acute ischemic stroke are substantially more heterogeneous than for acute MI, and available acute therapies are substantially more limited. In acute ischemic stroke patients, diagnostic evaluation is paramount in determining eligibility for treatment with the only approved therapy, which must be administered within 3 hours after stroke onset. For patients having acute MI, reperfusion therapy by percutaneous intervention or thrombolytic drug therapy is well established. Because atherosclerosis is a common pathway to acute MI and acute ischemic stroke, modifying associated known risk factors is required for primary and secondary prevention of both conditions. Pharmacologic therapies recommended for secondary prevention include beta-blockers and angiotensin-converting enzyme inhibitors for MI, oral anticoagulants for stroke, and statins and antiplatelet agents for both conditions. Aspirin is recommended for preventing recurrence of both MI and stroke; agents inhibiting the adenosine diphosphate pathway of platelet activation, such as ticlopidine and clopidogrel, are also beneficial. Recent studies suggest the benefits associated with adding aspirin to clopidogrel do not outweigh the significant increase in bleeding risk. The synergistic effects of aspirin plus extended-release dipyridamole make this combination twice as effective than aspirin alone in secondary prevention of ischemic stroke. An ongoing study is directly comparing the combination of aspirin plus extended-release dipyridamole with clopidogrel for the prevention of recurrent stroke.

Stent-Supported Angioplasty for Acute Stroke Caused by Carotid Dissection

Carotid dissection is a less common but important cause of acute ischemic stroke, which has specific treatment implications. We describe the case of a patient with acute, fluctuating neurological symptoms found to be caused by carotid dissection who underwent endovascular stent-supported angioplasty of this lesion with good outcome. Pros and cons of the various treatment options encountered in this case including intravenous thrombolysis, angioplasty and stenting, and antithrombotic therapy are discussed. Endovascular treatment of carotid dissection in acute stroke can be performed safely. Treatment must ultimately be individualized to each specific case.