Novel Therapeutic Approaches to Prevent Atherothrombotic Ischemic Stroke in Patients with Carotid Atherosclerosis

Abstract

Atherothrombotic stroke represents approximately 20% of all ischemic strokes. It is caused by large-artery atherosclerosis, mostly in the internal carotid artery, and it is associated with a high risk of early recurrence. After an ischemic stroke, tissue plasminogen activator is used in clinical practice, although it is not possible in all patients. In severe clinical situations, such as high carotid stenosis (≥70%), revascularization by carotid endarterectomy or by stent placement is carried out to avoid recurrences. In stroke prevention, the pharmacological recommendations are based on antithrombotic, lipid-lowering, and antihypertensive therapy. Inflammation is a promising target in stroke prevention, particularly in ischemic strokes associated with atherosclerosis. However, the use of anti-inflammatory strategies has been scarcely studied. No clinical trials are clearly successful and most preclinical studies are focused on protection after a stroke. The present review describes novel therapies addressed to counteract inflammation in the prevention of the first-ever or recurrent stroke. The putative clinical use of broad-spectrum and specific anti-inflammatory drugs, such as monoclonal antibodies and microRNAs (miRNAs) as regulators of atherosclerosis, will be outlined. Further studies are necessary to ascertain which patients may benefit from anti-inflammatory agents and how.

Quantifying Carotid Stenosis: History, Current Applications, Limitations, and Potential: How Imaging Is Changing the Scenario

“…Given this diverse landscape, an increasing body of literature suggests that recognizing unstable plaque characteristics might substantially improve the evaluation of carotid atherosclerosis in both symptomatic and asymptomatic individuals. This approach potentially offers greater predictive accuracy than stenosis measurement alone and aids clinicians in precisely tailoring medical or surgical interventions [94,95]. Identifying high-risk components in patients already receiving optimal medical care might indicate the necessity of revascularization in asymptomatic individuals or support a less invasive approach in symptomatic patients unsuitable for surgery.…”

Efectos de la Terapia en Espejo vs. Ejercicio Terapéutico Cognoscitivo en la mejora de las funciones del miembro superior en pacientes con ictus

“…-Aterotrombótico: se produce debido a una ateroesclerosis de una arteria de tamaño medio o grande, con o sin estenosis y con uno o más factores de riesgo cardiovascular (FRCV). Abarca la zona cortical o subcortical con localización vertebrobasilar o carotídea [43].…”