Ischemic stroke: From acute treatment to long-term recovery

Ischemic stroke (IS) is due to the sudden occlusion of a cerebral artery with the consequence of a critical reduction in cerebral blood flow in a localized region (rCBF) of the brain. It represents the second cause of death and the leading cause of neurological disability in developed countries. Primarily due to the resulting economic burden, IS is considered a world-wide challenge. Different strategies can be identified to face this challenge: acute treatment, primary and secondary prevention, rehabilitation. For several years acute IS treatment has been based on the use of the only current drug approved in the first 3 hours from symptom onset: recombinant tissue plasminogen activator (rtPA). However, mainly due to the short therapeutic window, a low percentage of patients can be actually treated by rtPA. Thus, with improving diffusion of more accurate diagnostic tools and of prognostic informations in different clinical scenarios, new treatment strategies in the acute phase have been developed such as intra-arterial and mechanical thrombolysis. Prevention plays a crucial role in counteracting the economic burden of IS through life-style changes, vascular risk factors control (with arterial hypertension being the main one for IS) and antiplatelet therapy. Moreover prevention therapy has been enriched by the introduction, in the last few years, of new drugs with pleiotropic effects such as statins and ACE-inhibitors. Also potential pleiotropic effects of antidiabetic drugs are currently under investigation. New insights in secondary prevention come from the use of phosphodiesterase inhibitors such as dipyridamole (in combination with aspirine) and cilostazol. The latter demonstrated to be more effective than aspirin in reducing the risk of recurrent stroke with the advantage of dramatically reducing the risk of haemorrhagic events as compared to aspirin. Rehabilitation strategies are weighted, together with acute IS treatment, by most of stroke physicians and patients expectations. Among them transcranial magnetic stimulation (TMS) is a new tool able to explore and affect critical aspects of neural plasticity, thus being of great importance in the understanding and treatment of those fundamental functional recovery mechanisms triggered after stroke. The present chapter will focus on standard, current and new potential treatments of acute phase, prevention and rehabilitation of IS. © 2013 Nova Scicence Publishers, Inc. All rights reserved.