Editor: Simone Peschillo

Brain Ischemic Stroke - From Diagnosis to Treatment

Volume 3

eBook: US $139 Special Offer (PDF + Printed Copy): US $255
Printed Copy: US $186
Library License: US $556
ISSN: 2405-7401 (Print)
ISSN: 2405-741X (Online)
ISBN: 978-1-68108-310-0 (Print)
ISBN: 978-1-68108-309-4 (Online)
Year of Publication: 2016
DOI: 10.2174/97816810830941160301

Introduction

Stroke is thought to be the second biggest killer worldwide, and is responsible for over 5 million deaths per year. Several strategies have been developed to enhance treatment of stroke patients. Multimodal neuroimaging allows physicians to diagnose and evaluate not only the ischemic core but also the vessel pattern and collateral status. Stroke Treatment involves extensive intravenous drug administration. Several new drugs with long lasting efficacy are now being tested in randomized clinical trials. In this context, endovascular treatment is a promising avenue that allows physicians to treat patients in extended time windows especially patients in whom intravenous RTPA has failed. A new era has emerged with new devices called stent retrievers and aspiration techniques, which have demonstrated higher rates of recanalization and clear superiority over previous devices employed in RCTs. The third volume of Frontiers in Neurosurgery presents updated information on ischemic stroke treatment. The volume comprehensively covers the epidemiology, physiology, diagnosis and treatment modalities of stroke. Readers will also find key information on diagnosing and treating rare and lesser known causes of stroke as well as notes about new devices and medical procedures to combat ischemic stroke. This volume is a useful resource for neurosurgery specialists as well as nurses, physiotherapists and caregivers.

Preface

Brain Ischemic Stroke - From Diagnosis to Treatment

Someone suffers a stroke every 40 seconds in the USA; every year over 15 million people throughout the world suffer a stroke and 5 million are left significantly disabled. Stroke is thought to be the second biggest killer worldwide, and is responsible for over 5 million deaths per year.

The total economic burden of stroke is of the order of £7bilion per annum in England and Wales.

Even though many efforts to treat as much as possible stroke patients have been made, many of it are still left undertreated, mainly due to the short time window and other contraindications for intravenous (i.v.) rtPA. Furthermore, much more evidence demonstrates that endovascular treatment, in selected patients, is much more resolutive.

Various strategies have been developed to increase the number of treated patients: regarding the diagnosis, new neuroimaging tools allows neurologists and neurointerventionists to evaluate either the ischemic core and the vessel pattern and collateral status; regarding medical treatment, new molecules are being tested in RCTs (randomized clinical trials) with extended time windows.

In this context, endovascular treatment is a new technique that allows neurointerventionists to treat patients in whom intravenous rtPA has failed and those in extended time windows, in particular in large-vessels occlusion.

Regarding this novel approach, a new era has emerged with new devices (i.e. stent-retrievers and aspiration techniques), which have demonstrated in recently published RCTs higher rates of recanalization and clear superiority compared to previous devices.

Several ongoing RCTs are now investigating whether bridging therapy is more effective than i.v. treatment alone, whether mechanical thrombectomy is more successful than the best medical treatment in patients ineligible for i.v. thrombolysis and which kind of endovascular treatment is much effective.

The purpose of this eBook is to take stock of the latest news on the ischemic stroke treatment.

In 2020, mortality will be doubled due to this serious disease; everyone, health care assistants, social assistants and politicians as well, should be first in line to fight this battle.

This eBook is addressed not only to specialists in the treatment of patients with ischemic stroke, but also nurses, physiotherapists and finally non-medical personnel whose task is to decide on health care.

Simone Peschillo
Department of Neurology and Psychiatry
Endovascular Neurosurgery/Interventional Neuroradiology
‘Sapienza’ University of Rome
Rome
Italy

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