Evidence-based treatment of patients with ischemic cerebrovascular disease.
The results of trials that study patients with defined lesions (atrial fibrillation without valvular heart disease, various severities of carotid artery stenosis in the neck, intracranial artery stenosis) are very helpful for clinicians caring for patients with those conditions. On the other hand, trials that group all patients with brain ischemia together are not very helpful. Modern technology now makes it possible to define quickly and safely: (1) the location, nature, and severity of causative cerebrovascular, cardiac, and aortic lesions; (2) blood constituents and coagulability; and, (3) the presence, location, and severity of ischemic brain damage. As in all medicine, treatment should be aimed at the cause of disease, not the time course and severity of present damage. Clearly, more trials are needed in patients who have been studied thoroughly using modern technology. Until then, clinicians must understand the context of the trial data to determine if the results are applicable to Mr. or Ms. Jones, and the patients sitting before them in the office or in the hospital bed.
Llinas
R
R
Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. rllinas@jhmi.edu
Caplan
L R
LR
D017130:Angioplasty; D000925:Anticoagulants / Q000627:therapeutic use; D002545:Brain Ischemia / Q000628:therapy*; D016893:Carotid Stenosis / Q000601:surgery; D004691:Endarterectomy; D019317:Evidence-Based Medicine; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015607:Stents; D015912:Thrombolytic Therapy
D000925:Anticoagulants; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors