2020–2021 BCSC Basic and Clinical Science Course™
1 Update on General Medicine
Chapter 6: Cerebrovascular Disease
Highlights
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“Time is brain.” The most important factor in successful thrombolytic treatment in patients with acute ischemic stroke is early treatment.
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Intravenous recombinant tissue plasminogen activator (rtPA) is strongly recommended for carefully selected patients who can be treated within 3 hours of onset of ischemic stroke.
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For those patients who present with disabling symptoms, such as a complete hemianopia or visual extinction, rtPA is recommended regardless of the degree of initial improvement.
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Mechanical thrombectomy using second-generation stent retrievers is highly recommended in eligible patients after ischemic stroke involving large cerebral arteries of the anterior circulation, regardless of age, stroke severity, or whether they were treated with rtPA.
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Patients with acute ischemic stroke who received rtPA should be given aspirin (160–325 mg/day) 24–48 hours after symptom onset to prevent recurrent stroke, reduce stroke mortality, and decrease morbidity.
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Intensive treatment with statins after stroke reduces risk of recurrent ischemic stroke and other cardiovascular events.
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Carotid endarterectomy (CEA) may be considered in patients with greater than 70% stenosis, but the benefit of CEA versus best medical therapy is controversial.
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Flow diverting stents may supplant traditional endovascular coiling or clipping techniques in the general surgical management of intracranial aneurysms.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.