PREVENTION OF ISCHEMIC STROKE Antiplatelet Agents, Carotid Endarterectomy and Angioplasty and Stenting

Abstract

Stroke is the most common acute neurologic disease and the second most common cause of death among persons living in Turkey. In addition, stroke is a leading cause of disability and human suffering. A preponderance of strokes is secondary to arterial occlusions often due to atherosclerosis. While useful therapies to treat acute stroke are available, prevention remains the most cost-effective strategy for treating patients with ischemic cerebrovascular disease. Components of management to lower the risk of stroke include identification and treatment of risk factors that accelerate atherosclerosis including hypertension, diabetes mellitus, hyperlipidemia, and smoking. In addition, most patients with arterial disease should be treated with an antiplatelet agent such as aspirin, clopidogrel, or aspirin/dipyridamole. New antiplatelet agents are being developed. Carotid endarterectomy is of proven utility in lowering the risk of stroke in carefully selected patients. The role of angioplasty and stenting for treatment of stenotic intracranial or extracranial arterial disease, including the internal carotid artery, is expanding rapidly. With a carefully developed plan addressing management of risk factors, antithrombotic medications and local interventions, the likelihood of ischemic stroke can be reduced.