Cerebrovascular Health: Stroke and Beyond

Öz

Stroke is a leading cause of death and long-term disability worldwide; however, cerebrovascular disease extends beyond the acute event, and small-vessel disease, covert infarcts, and microbleeds shape long-term cognitive and functional outcomes. This review synthesizes cerebrovascular health "from stroke and beyond" through a life-course lens, summarizing epidemiology and burden, care pathways from prehospital triage to endovascular reperfusion in acute ischemic stroke, organized stroke-unit care and early rehabilitation, mechanism-based secondary prevention, and small-vessel disease linked to vascular cognitive impairment. Evidence from guidelines, randomized trials, and large cohorts published between 2015 and 2025 indicates that the highest-yield strategies are persistent blood-pressure control, smoking cessation, statin-based intensive lipid lowering, atrial fibrillation screening with appropriate anticoagulation, timely carotid surgery for symptomatic stenosis, and aggressive medical therapy for intracranial atherosclerosis. In the acute phase, rapid and accurate imaging with intravenous thrombolysis and mechanical thrombectomy in eligible patients improves functional outcomes, while stroke-unit care and early rehabilitation are critical to consolidate gains. In conclusion, cerebrovascular health should be managed within an integrated continuum linking primary prevention, hyperacute therapy, organized unit care, early rehabilitation, and lifelong secondary prevention.

Anahtar Kelimeler

• stroke
• Cerebrovascular Disease
• Mechanical Thrombectomy
• Rehabilitation
• Secondary Prevention

Beyin Damar Sağlığı: İnme ve Ötesi

Öz

İnme, dünya çapında ölüm ve kalıcı sakatlığın önde gelen nedenlerinden biridir; ancak serebrovasküler hastalık akut olayla sınırlı değildir ve küçük damar hastalığı, sessiz enfarktlar ile mikrokanamalar uzun dönem bilişsel ve işlevsel sonuçları belirler. Bu derleme, beyin damar sağlığını "inme ve ötesi" sürekliliğinde, yaşam seyri perspektifiyle ele alarak epidemiyoloji ve hastalık yükünü, akut iskemik inmede hastane öncesi triyajdan endovasküler reperfüzyona uzanan bakımı, organize inme ünitesi ve erken rehabilitasyonu, mekanizmaya dayalı ikincil korunmayı ve vasküler bilişsel bozulmayla ilişkili küçük damar hastalığını bütüncül bir çerçevede özetlemektedir. 2015-2025 dönemine ait kılavuzlar, randomize çalışmalar ve büyük kohortlar temelli bulgular, en yüksek getirili stratejilerin ısrarlı hipertansiyon kontrolü, tütünün bırakılması, statin temelli yoğun lipid düşürme, atriyal fibrilasyon taraması ve uygun antikoagülasyon ile semptomatik karotiste zamanında cerrahi ve intrakranyal aterosklerozda agresif medikal tedavi olduğunu göstermektedir. Akut dönemde hızlı ve doğru görüntüleme eşliğinde uygun hastada intravenöz tromboliz ve mekanik trombektomi olarak beyin damar sağlığı, birincil korunma, hiperakut tedavi, organize ünite bakımı, erken rehabilitasyon ve yaşam boyu ikincil korunmayı birbirine bağlayan entegre bir modelle yönetilmelidir.

Anahtar Kelimeler

• İnme
• serebrovasküler hastalık
• mekanik trombektomi
• rehabilitasyon
• İkincil koruma

Kaynakça

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