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Review
. 2022 Apr 15;130(8):1075-1094.
doi: 10.1161/CIRCRESAHA.121.319947. Epub 2022 Apr 14.

Advances in Recurrent Stroke Prevention: Focus on Antithrombotic Therapies

Brian Mac Grory  1 , Shadi Yaghi  2 , Charlotte Cordonnier  3 , Luciano A Sposato  4 , Jose G Romano  5 , Seemant Chaturvedi  6
Affiliations
Review

Advances in Recurrent Stroke Prevention: Focus on Antithrombotic Therapies

Brian Mac Grory et al. Circ Res. .

Abstract

The past decade has seen significant advances in stroke prevention. These advances include new antithrombotic agents, new options for dyslipidemia treatment, and novel techniques for surgical stroke prevention. In addition, there is greater recognition of the benefits of multifaceted interventions, including the role of physical activity and dietary modification. Despite these advances, the aging of the population and the high prevalence of key vascular risk factors pose challenges to reducing the burden of stroke. Using a cause-based framework, current approaches to prevention of cardioembolic, cryptogenic, atherosclerotic, and small vessel disease stroke are outlined in this paper. Special emphasis is given to recent trials of antithrombotic agents, including studies that have tested combination treatments and responses according to genetic factors.

Keywords: atrial fibrillation; endarterectomy, carotid; foramen ovale, patent; randomized controlled trial; stroke.

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Figures

Figure 1
Figure 1
Schematic diagram for approach to acute antithrombotic therapy Reproduced with permission from Wolters Kluwer
Figure 2.
Figure 2.. Proposed Algorithm for the Diagnosis and Treatment of Cryptogenic Stroke
Panel A. Classical embolic stroke involving the cerebral cortex. Panel B. Bilateral small subcortical infarcts. Panel C. Small simultaneous subcortical infarcts involving the same vascular territory. Panel D. Single, large (>20 mm) deep infarct. Panel E. Embolic cerebellar infarct. Panel E. Lateral medullary infarct. ARCADIA, AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke. ESUS, embolic stroke of undetermined source. CT, computed tomography. MRI, magnetic resonance imaging. DWI, diffusion-weighted imaging. PFO, patent foramen ovale. HITS, high-intensity transient signals. TCD, transcranial Doppler ultrasound. No small vessel occlusion*, clinical TOAST criteria for small occlusion are a traditional lacunar syndrome and the absence of cortical deficits.
Figure 3
Figure 3
Intracranial atherosclerosis involving the distal vertebral artery
See this image and copyright information in PMC

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