Ischemic stroke accounts for approximately 80% of all strokes, and most of the remainder are hemorrhagic subtypes. Most ischemic strokes are due to intracranial vessel occlusion, the majority resulting from embolism from the heart or extracranial vessels. Advances in medical treatment of ischemic stroke have included administration of thrombolytic substances, which have proven to be effective in improving outcome after ischemic stroke. Atheromatous disease of the cervical carotid artery is the most important source of embolic disease from extracranial cerebral vasculature. Prospective randomized trials of surgery versus medical therapy have established the role of carotid endarterectomy for stroke prevention in symptomatic and asymptomatic patients with high-grade carotid stenosis. Endovasu-lar therapy, including angioplasty and stent-ing, is being investigated as an alternative to carotid endarterectomy for stroke prevention in these patients.
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