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  • image Stroke can be either ischemic (87%) or hemorrhagic (13%) and the two types are treated differently.
  • image Transient ischemic attacks (TIAs) require urgent intervention to reduce the risk of stroke, which is known to be highest in the first few days after TIA.
  • imageCarotid endarterectomy should be performed in ischemic stroke patients with 70% to 99% stenosis of the ipsilateral carotid artery, provided that it is done in an experienced center.
  • image Carotid stenting is an option for stroke patients eligible for carotid endarterectomy, especially in patients less than 70 years of age.
  • image Early reperfusion (<4.5 hours from onset) with tissue plasminogen activator (tPA) has been shown to reduce the ultimate disability due to ischemic stroke.
  • image Antiplatelet therapy is the cornerstone of antithrombotic therapy for the secondary prevention of noncardioembolic ischemic stroke.
  • image Oral anticoagulation is recommended for the secondary prevention of cardioembolic stroke in moderate- to high-risk patients.
  • image Blood pressure lowering is effective in both the primary and secondary prevention of both ischemic and hemorrhagic stroke regardless of blood pressure.
  • image Blood pressure lowering in the acute ischemic stroke period (first 7 days) may result in decreased cerebral blood flow and worsened symptoms.
  • imageStatin therapy is recommended for all ischemic stroke patients, regardless of baseline cholesterol, to reduce stroke recurrence.

On completion of this chapter, the reader will be able to:

  1. Describe the impact of stroke on the general population of the United States (incidence and outcomes).

  2. Identify the known risk factors for stroke in a patient with either an ischemic or a hemorrhagic stroke.

  3. Determine which risk factors are modifiable in a given stroke patient and develop a strategy for risk reduction.

  4. Given a patient presentation, differentiate cardioembolic stroke from other causes of ischemic stroke.

  5. Explain the pathophysiologic mechanism underlying the development of acute ischemic stroke.

  6. List the major arteries supplying blood to the brain and their approximate location.

  7. Compare and contrast transient ischemic attack (TIA) and acute ischemic stroke.

  8. Propose a plan for the diagnostic workup of a patient with presumed ischemic stroke.

  9. Discuss the relative merits of anticoagulation with unfractionated heparin in the management of acute ischemic stroke.

  10. Given a patient case, select an appropriate antiplatelet regimen for the prevention of secondary ischemic stroke.

  11. Develop monitoring plans for patients receiving aspirin, clopidogrel, and dipyridamole + aspirin for the prevention of ischemic stroke.

  12. Assess a patient’s eligibility to receive IV thrombolytic therapy, given a diagnosis of acute ischemic stroke.

  13. Plan a treatment strategy for using IV thrombolytic therapy in acute ischemic stroke, including an individual monitoring plan.

  14. Determine whether a stroke patient is a candidate for carotid endarterectomy (CEA) for stroke prevention.

  15. Evaluate the role of pharmacogenetic testing in the use of warfarin and clopidogrel in stroke patients.

image Stroke is the leading cause of disability among adults and the fourth leading cause of death in the United States, behind cardiovascular disease, cancer, and chronic lower respiratory diseases.1 Despite a 30% reduction in stroke mortality between 1995 and 2005, stroke occurs in the United States at ...

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