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(Circulation. 2001;103:2321.)
© 2001 American Heart Association, Inc.

Editorials

Preventing Stroke

Is Preventing Microemboli Enough?

James C. Grotta, MD; Andrei V. Alexandrov, MD

From the Stroke Program, University of Texas-Houston Medical School.

Correspondence to James C. Grotta, MD, Professor of Neurology and Director, Stroke Program, The University of Texas-Houston Medical School, MSB 7.044, 6431 Fannin St, Houston, TX 77030.

Key Words: Editorials • stroke • ultrasonics

Prevention of stroke shares much in common with prevention of other vascular events because the underlying pathological process, namely, atherosclerosis, is the same. Attesting to this is the recent demonstration that statins,¹ ACE inhibitors,² and more well-known measures, such as control of hypertension and smoking, are as effective in preventing stroke³ as they are in preventing other cardiovascular events.

However, there is a pathological process, namely, embolization, that leads to arterial occlusion in the cerebral circulation much more frequently than in the coronary bed. Consequently, the detection and prevention of embolic events is critical to reducing the burden of stroke. Emboli may cause either large disabling strokes or small subclinical events, depending on the size and eventual location of the embolus. Emboli generated from the chambers or valves of the heart or from atherosclerotic plaques in the arteries of the neck are variable in their size and consistency. When the cardiac chambers are dyskinetic or fibrillating, leading to stasis and the formation of thrombus, distal emboli are usually large, they lodge in the initial branches of the circle of Willis, and the resultant strokes are devastating. The posterior wall of the most proximal portion of the internal carotid artery just distal to the bifurcation is a common site of atherosclerosis because of the unique hemodynamic effects caused by the flow divider. Emboli from such large-artery atheroma may consist of a thrombus or pieces of calcified plaque, but they may also be microscopic if composed only of fibrin-platelet material. If such . . . [Full Text of this Article]