Evidence-based therapeutic options for
stroke continue to emerge based on results from well-designed clinical studies.
Ischemic stroke far exceeds
hemorrhagic stroke in terms of prevalence and incidence, both in the USA and worldwide. The public health effect of reducing death and disability related to
ischemic stroke justifies the resources that have been invested in identifying safe and effective treatments. The emergence of novel oral
anticoagulants for
ischemic stroke prevention in
atrial fibrillation has introduced complexity to clinical decision making for patients with this common
cardiac arrhythmia. Some accepted
ischemic stroke preventative strategies, such as carotid revascularization for asymptomatic
carotid stenosis, require reassessment, given advances in risk factor management, antithrombotic
therapy, and surgical techniques. Intra-arterial
therapy, particularly with
stent retrievers after intravenous
tissue plasminogen activator, has recently been demonstrated to improve functional outcomes and will require investment in system-based care models to ensure that effective treatments are received by patients in a timely fashion. The purpose of this review is to describe recent advances in medical and surgical approaches to
ischemic stroke prevention and acute treatment. Results from recently published clinical trials will be highlighted along with ongoing clinical trials addressing key questions in
ischemic stroke management and prevention where
equipoise remains.