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(Stroke. 2005;36:208.)
© 2005 American Heart Association, Inc.

Advances in Stroke 2004

Emerging Therapies for Cerebrovascular Disorders

From the Department of Neurosciences (A.D.), Universitat Autonoma de Barcelona, Spain; and the Department of Neurology (M.F.), University of Massachusetts Medical School, Worcester.

Correspondence to Dr Marc Fisher, Department of Neurology, University of Massachusetts Medical School, 119 Belmont St, Worcester, MA 01605. E-mail fisherm@ummhc.org

Key Words: Advances in Stroke • intracerebral hemorrhage • stroke, acute • stroke prevention

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Several important advances were reported over the past year that impacted on emerging therapies for cerebrovascular disorders. In addition to therapies directed at the acute treatment and prevention of ischemic stroke, trial results of treatments for intracerebral hemorrhage (ICH) also were reported. This brief review will focus on the most important recent stroke therapy reports.

ICH is a devastating disease that currently has no effective medical treatment. Surgical evacuation typically is considered in younger patients with lobar hemorrhages and a deteriorating clinical course, but the role of surgery remains controversial.¹ Two recent reports provide important new information to guide clinicians in this therapeutic area. The International Surgical Trial in Intracerebral Hemorrhage (ISTICH)² randomized >1000 patients to "early surgery" of the hematoma or "initial conservative treatment." Patients were included if they had a spontaneous supratentorial ICH within 72 hours from symptom onset and there was clinical uncertainty as to the need for surgical evacuation. The 2 groups were well balanced and the hemorrhages were located in basal ganglia or thalamus in 50% of cases. More than 25% of patients who were randomized to initial conservative treatment later went on to surgery because of neurological deterioration. Favorable outcome at 6 months, based on change of a dichotomized prognosis at time of presentation calculated according to illness severity, was achieved by 26.1% of patients in the early surgery group and by 23.8% in the initial conservative treatment group (odds ratio, 0.89; 95% CI, 0.66 to 1.19). There was no difference in mortality rate, . . . [Full Text of this Article]