From the Guidelines
Ischemic strokes are a type of stroke that occurs when blood flow to the brain is blocked by a clot or narrowed blood vessel, accounting for approximately 88% of all strokes, and can be classified as thrombotic or embolic, with risk factors including nonmodifiable and modifiable factors such as age, hypertension, and hyperlipidemia. The most recent and highest quality study 1 provides evidence that ischemic strokes are a major cause of morbidity and mortality, and that control of multiple stroke risk factors via comprehensive lifestyle modification and pharmacological therapy can prevent a first or recurrent stroke. Some key points to consider in the management and prevention of ischemic strokes include:
- Risk factors for ischemic stroke can be classified into nonmodifiable risk factors, such as age, race, and family history, and modifiable risk factors, such as hypertension, diabetes, and hyperlipidemia 1
- Treatment of ischemic stroke focuses on restoring blood flow, with intravenous tissue plasminogen activator (tPA) being a primary medication if given within a certain time frame of symptom onset, and mechanical thrombectomy being an option in some cases 1
- Prevention of ischemic stroke typically includes antiplatelet therapy, such as aspirin or clopidogrel, and management of underlying risk factors, with the goal of reducing the risk of recurrent stroke and other vascular outcomes 1
- Recognizing stroke symptoms using the FAST method (Face drooping, Arm weakness, Speech difficulties, Time to call emergency services) is crucial, as immediate treatment can significantly improve outcomes by limiting the extent of brain damage. Overall, the management and prevention of ischemic strokes requires a comprehensive approach that takes into account the individual patient's risk factors and medical history, with the goal of reducing morbidity, mortality, and improving quality of life.
From the Research
Definition and Causes of Ischemic Strokes
- Ischemic strokes occur when the arteries supplying blood to the brain are narrowed or blocked, inducing damage to brain tissue due to a lack of blood supply 2.
- Ischemic stroke is generally the result of an atherothrombotic process leading to vessel obstruction or narrowing 3.
- There are two types of ischemic stroke: thrombotic stroke, caused by a thrombus that develops within the cerebral vasculature, and embolic stroke, which arises from a distant embolus that lodges in a cerebral artery 3.
Risk Factors and Symptoms
- Risk factors for the development of ischemic stroke include hypertension, diabetes, dyslipidemia, smoking, atrial fibrillation, prior stroke, and transient ischemic attack 3.
- The neurologic manifestations of stroke depend on the location of injury in the brain and the degree of ischemia or infarction 3.
- Symptoms may be reversible or irreversible and range from sensory deficits to hemiplegia 3.
Treatment and Prevention
- Tissue plasminogen activator is currently the only available drug treatment for acute ischemic stroke 3.
- Antithrombotic therapy is essential for secondary prevention, with oral antiplatelet therapies such as aspirin, clopidogrel, and the extended-release dipyridamole plus aspirin combination being acceptable first-line agents 3, 4.
- Dual antiplatelet therapy with clopidogrel and aspirin may provide greater protection against subsequent stroke than monotherapy, especially when started during the early acute ischemic phase 5.
- Lifestyle changes and drug therapy are important components of primary and secondary prevention strategies in ischemic stroke, including the aggressive treatment of risk factors such as elevated blood pressure and high cholesterol 3.
Pathology and Mechanisms
- Ischemic stroke involves complex mechanisms, including oxidative/nitrosative stress, excitatory amino acids and their receptors, inflammatory signaling molecules, metabolic pathways, and ion channels 2.
- Inflammation plays a prominent role in secondary injury after ischemic stroke, with various cellular and molecular mediators involved 6.