In this article, we discuss major advances in the treatment and prevention of ischemic stroke that have taken placed in the past 3 years. The most important advance in acute stroke treatment is the validation and widespread adoption of intra-arterial therapies for the treatment of acute ischemic stroke. Five clinical trials spanning multiple continents were published in early 2015 that proved that intra-arterial treatment - both with and without tPA - is beneficial in improving functional recovery after stroke. Emerging literature (including the DAWN trial) also suggests that patients can be treated up to 24 hours after the onset of symptoms based on the size of the infarct core obtained using MRI Perfusion or CT Perfusion imaging. With respect to stroke secondary prevention, widespread adoption of long-term cardiac monitoring has increased the detection rate of atrial fibrillation (as demonstrated in the EMBRACE and CRYSTAL-AF trials). Pioglitazone (an oral hypoglycemic agent of the thiazolidinedione drug class) was shown in the IRIS trial to reduce the risk of recurrent stroke in patients with impaired glucose tolerance who had not developed type 2 diabetes mellitus.
Keywords: Ischemic stroke; atrial fibrillation; embolism; mechanical thrombectomy; pioglitazone; transient ischemic attack.