[Stroke. Diagnosis and therapeutic management of cerebrovascular disease]. / Ictus. Diagnóstico y tratamiento de las enfermedades cerebrovasculares.

Stroke is the second cause of death and the first cause of disability with an important economical cost. Thrombolysis and stroke units are the major contribution to stroke treatment of the last years changing a nihilist therapeutic attitude towards an active attitude, stroke is a medical emergency. Treatment with rtPA has shown to be effective in the first 3 hours following stroke and the FDA and the European Medical Agency (EMEA) have approved its use. A protocolised management of the acute phase to treat physiological complications is the mainstone of stroke units showing a reduction in mortality and disability. Multiple strategies are under development in order to treat more patients, drugs with a longer therapeutic window, intravenous thrombolysis followed by intrarterial thrombolysis, selection of patients with mismatch with new neuroimaging techniques and neuroprotective therapies. Preventive treatment has also experienced a change due to a better knowledge of the ethiopathogeny, the role of vascular risk factors and the development of new preventive drugs. Knowledge of cerebrovascular diseases is today's clue for the best treatment of our patients.

Ictus. Diagnóstico y tratamiento de las enfermedades cerebrovasculares / Stroke. Diagnosis and therapeutic management of cerebrovascular disease

En nuestro medio, el ictus es la segunda causa de muerte y la primera de discapacidad, con un gran impacto económico. La trombolisis y las unidades de ictus son la mayor contribución al tratamiento del ictus de los últimos años y han cambiado una actitud nihilista por una actitud activa, ya que el ictus es una emergencia médica. El activador tisular del plasminógeno recombinante es eficaz en las primeras 3 h del inicio del ictus y la Food and Drug Administration y la Agencia Europea del Medicamento han aprobado su uso. La actuación protocolizada durante la fase aguda para corregir alteraciones fisiológicas es el fundamento de las unidades de ictus, y muestra una reducción de la mortalidad y la discapacidad. Se están desarrollando múltiples estrategias para tratar a un mayor número de pacientes, como los fármacos con mayor ventana terapéutica, la trombolisis intravenosa combinada con intraarterial, la identificación de pacientes con penumbra isquémica mediante nuevas técnicas de neuroimagen y los tratamientos neuroprotectores para evitar mayor daño cerebral. El tratamiento preventivo también ha experimentado un cambio por el mejor conocimiento de la etiopatogenia, el papel de los factores de riesgo vascular y el desarrollo de nuevos fármacos. El conocimiento de la enfermedad cerebrovascular y su adecuado tratamiento es hoy día imprescindible para el mejor tratamiento de los pacientes con ictus (AU)

Stroke is the second cause of death and the first cause of disability with an important economical cost. Thrombolysis and stroke units are the major contribution to stroke treatment of the last years changing a nihilist therapeutic attitude towards an active attitude, stroke is a medical emergency. Treatment with rtPA has shown to be effective in the first 3 hours following stroke and the FDA and the European Medical Agency (EMEA) have approved its use. A protocolised management of the acute phase to treat physiological complications is the mainstone of stroke units showing a reduction in mortality and disability. Multiple strategies are under development in order to treat more patients, drugs with a longer therapeutic window, intravenous thrombolysis followed by intrarterial thrombolysis, selection of patients with mismatch with new neuroimaging techniques and neuroprotective therapies. Preventive treatment has also experienced a change due to a better knowledge of the ethiopathogeny, the role of vascular risk factors and the development of new preventive drugs. Knowledge of cerebrovascular diseases is today's clue for the best treatment of our patients (AU)