Pathogenetic mechanisms of ischemic stroke: from verification to secondary prevention

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Abstract

Ischemic stroke is an extremely heterogeneous disease: there are more than 200 causes of cerebral catastrophe. Early identification of the pathogenetic mechanism (subtype) of ischemic stroke allows planning an individual secondary prevention strategy, which includes a wide range of pharmaceutical and surgical methods. The article presents the characteristics of cardioembolic (associated with atrial fibrillation and flutter, prosthetic valves, chronic heart failure, left ventricle thrombus, infective endocarditis, open foramen ovale, etc.), atherothrombotic (due to extra- and intracranial atherosclerosis), lacunar and cryptogenic stroke, as well as less common causes of the disease, in particular cervical or cerebral artery dissection. Issues of secondary prevention of stroke according to the pathogenetic subtype are described and summarized as an algorithm. The article is illustrated with clinical examples.

About the authors

Aleksey A. Kulesh

Wagner Perm State Medical University

Author for correspondence.
Email: aleksey.kulesh@gmail.com
ORCID iD: 0000-0001-6061-8118

D. Sci. (Med.), Assoc. Prof.

Russian Federation, Perm

Dmitrii A. Demin

Federal Center for Cardiovascular Surgery

Email: demin2404@mail.ru
ORCID iD: 0000-0003-2670-4172

neurologist

Russian Federation, Astrakhan

Oleg I. Vinogradov

Pirogov National Medical and Surgical Center

Email: olvinog1975@gmail.com
ORCID iD: 0000-0002-3847-9366

D. Sci. (Med.), Prof.

Russian Federation, Moscow

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