Recommendations for Management of Patients with Carotid Stenosis

Stroke is a one of the leading causes of morbidity and mortality in the world. Carotid atherosclerosis is recognized as an important factor in stroke pathophysiology and represents a key target in stroke prevention; multiple treatment modalities have been developed to battle this disease. Multiple randomized trials have shown the efficacy of carotid endarterectomy in secondary stroke prevention. Carotid stenting, a newer treatment option, presents a less invasive alternative to the surgical intervention on carotid arteries. Advances in medical therapy have also enabled further risk reduction in the overall incidence of stroke. Despite numerous trials and decades of clinical research, the optimal management of symptomatic and asymptomatic carotid disease remains controversial. We will attempt to highlight some of the pivotal trials already completed, discuss the current controversies and complexities in the treatment decision-making, and postulate on what likely lies ahead. This paper will highlight the complexities of decision-making optimal treatment recommendations for patients with symptomatic and asymptomatic carotid stenosis

Gender differences in stroke

Everyone is aware ofmany differences betweenmen andwomen in everyday life. But, howdifferent arewe in copingwith diseases?Nowadays, results of stroke studies more often point out gender differences. It has been shown that men and women have a different profile of vascular risk factors, different response to medical treatment, therapeutic interventions, as well as post-stroke disability and care. Data have shown women to be significantly older than men when stroke occurs, more likely to suffer cardioembolic stroke and have atrial fibrillation as a risk factor. Also, stroke onset differs among men and women. Acute stroke in women commonly presents with a coma, paralysis, aphasia, swallowing difficulties and urinary incontinence. Women also show greater disability and handicap after stroke, than men. There has been a noted difference as to where patients are discharged after hospital stay. While women are more often discharged to a chronic facility, men more often return home. These differences may imply some social differences, but also point out the need for careful future management and healthcare planning

Stroke prevention: recent achievements and new challenges

Stroke remains a major health problem despite the great efforts made worldwide to fight against it. Despite therapeutic achievements to treat ischemic stroke patients in stroke units with tissue plasminogen activator (tPA), prevention remains the most powerful strategy to cure this complex disease. Stroke is a heterogeneous and multi-factorial disease caused by the combination of vascular risk factors, environment, and genetic factors. These risk factors can be subdivided into non-modifiable (age, sex, race-ethnicity, genetic variations and predispositions) and modifiable (hypertension, diabetes, dyslipidemia, atrial fibrillation, carotid artery stenosis, smoking, poor diet, physical inactivity and obesity). The metabolic syndrome, a cluster of metabolic risk factors within an individual, has been recognized as and important factor associated with an increased risk of stroke. Recently, a great emphasis has been given to the investigations of genetic factors and stroke risk, which may lead to the discovery of new biomarkers for prevention, diagnosis and to the alternative strategies for stroke treatment. In this review we sought to discuss the main risk factors for stroke and the current strategies of stroke prevention

Stroke in young

Stroke is a major healthcare problem ranking as the third leading cause of death and the first cause of disability in the Western countries. Although young adults are at a lower risk of stroke compared to older people, strokes affecting those who are at earlier stages of their productive lives have a greater social impact in terms of number of years of lost productivity and disability. The incidence of stroke in young people ranges between 60 to 200 new cases per year per one million inhabitants, and the overall incidence is about one episode per 100,000 patients per year. Stroke in the young is more frequent in change with industrialized countries, in women, and in blacks and Hispanics compared to whites. In this review we sought to discuss the risk factors, and specific diseases and causes associated with stroke in the young.Moreover, we will discuss the genetic impact on stroke in young, and the outcome and prognosis after stroke among young adults