377 Ch 376. Cerebrovascular Diseases: Ischemic Stroke

Stroke = 2nd leading cause of death worldwide + leading cause of long-term disability；ischemic ~ 85% vs hemorrhagic 15% (ICH 10% + SAH 5%)；TOAST etiology classification: (1) large-artery atherosclerosis, (2) cardioembolic (AF most common), (3) small-vessel (lacunar), (4) other (dissection, vasculitis, hypercoagulable, paradoxical, drugs), (5) cryptogenic；acute treatment paradigm shift 2015-2024: IV thrombolysis alteplase ≤ 4.5 hr → tenecteplase TNK (single bolus, easier, equivalent — ATTEST/AcT/TWIST 2022); mechanical thrombectomy ≤ 6 hr standard → extended window ≤ 24 hr (DAWN, DEFUSE-3 2018) with perfusion imaging mismatch; MR-CLEAN-LATE (2023) extended window without strict imaging criteria；secondary prevention: antiplatelet (aspirin, clopidogrel, DAPT short-term per CHANCE/POINT/THALES) + anticoagulation (AF) + statin (intensive) + BP + DM + smoking + carotid intervention + PFO closure (RESPECT/REDUCE/CLOSE)；post-stroke care: dysphagia screen + DVT prevention + rehab + depression。