The Heart and the Brain

Stroke is the third most common reason for death, the second for dementia, and the most common cause for permanent disability. About 25% of all strokes are caused by a cardiac source of embolism, most frequently atrial. Acute stroke should be treated in dedicated stroke units. Systemic thrombolysis with recombinant tissue plasminogen activator in a time window up to 4.5 hours or endovascular recanalization up to 6 hours is effective in decreasing permanent disability after ischaemic stroke. Secondary prevention of stroke following a cardiogenic transient ischaemic attack or stroke should mostly be performed with oral anticoagulation which is clearly superior to acetylsalicylic acid (aspirin). Antiplatelet therapy is indicated in patients with ischaemic stroke and no cardiac source of embolism. Both clopidogrel monotherapy and the combination of aspirin plus extended-release dipyridamole are superior to aspirin monotherapy. In patients with a symptomatic high-degree stenosis of the internal carotid artery, endarterectomy has a slightly lower complication rate compared to stenting and balloon angioplasty with a similar long-term outcome.