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Abstract
In the past decade, the definition of stroke has been revised and major advances have
been made for its treatment and prevention. For acute ischaemic stroke, the addition
of endovascular thrombectomy of proximal large artery occlusion to intravenous alteplase
increases functional independence for a further fifth of patients. The benefits of
aspirin in preventing early recurrent ischaemic stroke are greater than previously
recognised. Other strategies to prevent recurrent stroke now include direct oral anticoagulants
as an alternative to warfarin for atrial fibrillation, and carotid stenting as an
alternative to endarterectomy for symptomatic carotid stenosis. For acute intracerebral
haemorrhage, trials are ongoing to assess the effectiveness of acute blood pressure
lowering, haemostatic therapy, minimally invasive surgery, anti-inflammation therapy,
and neuroprotection methods. Pharmacological and stem-cell therapies promise to facilitate
brain regeneration, rehabilitation, and functional recovery. Despite declining stroke
mortality rates, the global burden of stroke is increasing. A more comprehensive approach
to primary prevention of stroke is required that targets people at all levels of risk
and is integrated with prevention strategies for other diseases that share common
risk factors.