Year : 2018 | Volume
: 11 | Issue : 1 | Page : 1-
Secondary stroke prevention offers now more choices and is critical to reduce the burden of recurrent stroke and death
World Stroke Organisation; Department of Clinical Neurosciences and Prevention, Danube University Krems, Krems, Austria
World Stroke Organisation, Department of Clinical Neurosciences and Prevention, Danube University Krems, Krems
|How to cite this article:|
Brainin M. Secondary stroke prevention offers now more choices and is critical to reduce the burden of recurrent stroke and death.Hamdan Med J 2018;11:1-1
|How to cite this URL:|
Brainin M. Secondary stroke prevention offers now more choices and is critical to reduce the burden of recurrent stroke and death. Hamdan Med J [serial online] 2018 [cited 2018 Apr 20 ];11:1-1
Available from: http://www.hamdanjournal.org/text.asp?2018/11/1/1/228868
Worldwide, 17 million strokes occur per year, that is one stroke every 2 s. Nearly 6.5 million deaths occur due to stroke and 26 million survivors of stroke are alive at any time. Today, stroke is the number two cause of death in adults worldwide. It has become the number one cause of death in China, India, Russia and Brazil and a number of other countries. Overall, one in six people will suffer a stroke in their lifetime (all data from worldstrokeorganisation.org).
Many achievements have been made in acute therapy of ischemic stroke ranging from acute stroke units to thrombolysis and thrombectomy. Specialised stroke units are superior to normal treatment units in hospitals and can save lives and prevent disability. Intravenous thrombolysis can reduce the consequences of the infarct when applied early within 4 h after stroke onset, and this increases the number of survivors as well as the number of complete remissions. More recently, acute thrombectomy has been made available in many comprehensive stroke centres to be applied within 6 h after stroke onset. When used appropriately with sophisticated imaging, it may even be performed up to 24 h after the onset of stroke in selected cases. This may result in a sensational number to treat of 2.
Why then, one may ask, is stroke then a growing epidemic with increasing proportions of adult populations affected? If treatment and management promise such a good outcome why are there still so many stroke victims?
One answer is that stroke units and specialised stroke care are still not universally available and must be set up in many countries and regions in the world. Training of personnel is needed and time-is-brain management must be installed also in the preclinical phase. To speed up delivery of patients to stroke care facilities, recognition of stroke symptoms among laypersons and professionals must be improved. To reduce time delays, mobile computed tomography ambulances have been developed. Often, time delays are due to ignorance and wishful thinking that symptoms go away on their own. On the other hand, the decision to undergo treatment is often delayed and prevents many persons seeking hospital care.
The main effectiveness to reduce the burden of stroke lies in prevention rather than treatment and prevention focuses on the reduction of risk factors that are modifiable. Large studies have shown that up to 90% of all strokes are caused by modifiable risk factors, among them arterial hypertension, smoking, lack of physical exercise and nutritional factors. This applies equally for secondary prevention. The management of risk factors is a crucial issue for the prevention of further strokes. In addition, a number of drugs have been shown to be quite useful and can prevent a second occurrence after a transient ischemic attack or stroke. Among them are antithrombotics, statins and a number of new anticoagulants that have been proven to be more effective and more safe compared to conventional therapy with warfarin. Furthermore, in selected cases with high-grade stenosis, carotid thrombectomy or stenting may be helpful. Overall, secondary prevention of stroke now includes a wider management with more options that these have to be mastered by the treating physician.