Therapy in cerebrovascular disease: current status and future directions.
OBJECTIVE
To assess the current status and future directions of therapy in cerebrovascular disease.


METHODS
English language literature search using MEDLINE, Index Medicus, reviews, texts and relevant papers.


METHODS
Information has been drawn from approximately 200 articles.


METHODS
Those articles with most relevance to current practice and future directions in the therapy of cerebrovascular disease have been cited.


CONCLUSIONS
Much progress has been made over the last 30 years in the therapy of primary and secondary prevention of cerebrovascular disease. The introduction of antihypertensive agents has been largely responsible for the decline in mortality from stroke and, in some areas, the incidence. Anticoagulants such as warfarin protect against ischaemic stroke in patients with mitral or aortic valve disease and/or atrial fibrillation. Antiplatelet agents are clearly effective in the secondary prevention of ischaemic stroke after transient ischaemic attacks; the risk of stroke or death is reduced, on average, by 22%. In patients with subarachnoid haemorrhage, ischaemic complications caused by vasospasm are reduced by calcium channel blockers. A new wave of therapies is now on the horizon to minimise tissue damage in the early stages of ischaemic stroke ("tissue rescue") with the introduction of thrombolytic agents, calcium channel blockers, NMDA antagonists and haemodilution techniques and many of these are currently being subjected to clinical trial. If they prove to be effective, our current management of acute ischaemic stroke may alter dramatically.
Donnan
G A
GA
Department of Neurology, Austin Hospital, Heidelberg, VIC.
D000367:Age Factors; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002544:Cerebral Infarction / Q000188:drug therapy / Q000209:etiology; D002561:Cerebrovascular Disorders / Q000188:drug therapy* / Q000517:prevention & control; D005544:Forecasting; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy / Q000517:prevention & control; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000188:drug therapy / Q000517:prevention & control
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin