Volume 212 - Issue 1
Advances in stroke medicine
Authors: Suk Cheng and Toby Richards
Med J Aust 2020; 212 (1): 46-46.e1. || doi: 10.5694/mja2.50431
Published online: 13 January 2020
Published online: 13 January 2020
To the Editor: Reperfusion therapies in acute ischaemic stroke have become well recognised in recent years. The article by Campbell1 summarises current practice and addresses the benefits and challenges of several reperfusion therapies, but it misses one key prevention strategy.
Carotid stenosis is a significant cause of ischaemic stroke — it is present in about 20% of patients with stroke2 — and can lead to the formation of thromboembolism or haemodynamic failure from hypoperfusion.3
Multidisciplinary care is vital to the management of acute stroke, and carotid endarterectomy is a safe and effective procedure that significantly reduces the risk of stroke and improves perfusion to the brain.4 Carotid endarterectomy plays an important role as reperfusion therapy in acute ischaemic stroke and is integral clinical practice in the management of stroke.5
Competing interests
No relevant disclosures.
References
- Campbell BC. Advances in stroke medicine. Med J Aust 2019; 210: 367–374. https://www.mja.com.au/journal/2019/210/8/advances-stroke-medicine
- Cheng SF, Brown MM, Simister RJ, Richards T. Contemporary prevalence of carotid stenosis in patients presenting with ischaemic stroke. Br J Surg 2019; 106: 872–878.
- Momjian‐Mayor I, Baron JC. The pathophysiology of watershed infarction in internal carotid artery disease: review of cerebral perfusion studies. Stroke 2005; 36: 567–577.
- Caplan LR, Hennerici M. Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke. Arch Neurol 1998; 55: 1475–1482.
- Orrapin S, Rerkasem K. Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database Syst Rev 2017; (6): CD001081.