Stroke: a vascular pathology with inadequate management.

Stroke is a leading cause of death and disability in the world, and the worldwide burden from stroke will increase further during the 21st century. Major advances in the treatment and prevention of stroke have occurred but additional measures are needed. Much of the modern care of stroke mimics the modern treatment of heart disease, in part because of the success of thrombolytic therapy in improving outcomes. Nevertheless, the impact of thrombolytic therapy is limited because of the short therapeutic window. Additional measures are needed to limit the neurological consequences of stroke. Prevention remains a critical component of the management of patients with cerebrovascular disease. Although surgical therapies and antithrombotic medications (antiplatelet agents and anticoagulants) are effective in lessening the likelihood of stroke or recurrent stroke, new strategies are needed to lower the risk further. Measures aimed at stabilizing the vascular endothelium or preventing fracture of atherosclerotic plaques show great promise. Medications including cholesterol-lowering agents and antihypertensive medications, such as the angiotensin-converting enzyme inhibitors, appear effective in stroke prevention. These agents could be combined with antithrombotic agents and surgical interventions to lessen the risk of stroke.