• Isquemic: Clots of blood or plates of ateroma that block the arteries, causing among the 70-80% of all the ACV´s.
  
  

• Hemorrhagic: When the blood vessels break, they cause a bleeding.  They are caused generally by the sudden rise of the arterial tension and other times results of breakage of aneurysms or arteriovenosas malformations .  They represent approximately the 20% of the ACV´s. 
  
   

The main cause of ACV or ischemic stroke  is the carotid  disease (CD).  In the EC, a plate of ateroma is formed which diminishes the light of the artery.  This process is silent until it finishes ocluding completely, when small fragments of that plate are removed and distally oclude smaller branches of the brain, blocking the blood flow. 

The nature and severity of the symptoms will depend on the area of the brain affected and if collateral flow exists to the brain from other arteries.   

Formation of a coagulation on a plate ateroma with the consequent reduction of the blood.

The most common symptoms are:

• Weakness or abrupt paralysis in the face, arms, legs, generally of one side of the body.  
  
• Abrupt difficulty to speak or to understand what is being said.
• Sudden visual problems such as double vision, blurry vision or partial blindness in one or in both eyes.  
  
• Difficulty to walk, sicknesses or lack of coordination.  
  
• Severe headache of abrupt apparition.   

If you have some of these symptoms, go immediately to the medical ER, even if these disappear quickly.  Each minute counts.  The cerebral tissues do not die immediately after the stroke, for which if the occluded vessels are reopened in the 3 to 6 hours of the stroke, the chances of recovery increase notably.  From this fact comes the phrase 'time is brain' .   

Which are the factors of risk for the ACV?

• Arterial hypertension. 
• High cholesterol. 
• Coronary illness. 
• Arteriosclerosis.
• AVC or AIT subject.
• Tobacco.
• Alcohol.
• Age.
• Family history of strokes o.
• Diabetes.
• Anaemia of sickle-shaped cells.
• Hiperhomocísteinemia.

Can the ACV be diagnosed?   

Numerous diagnostic tests exist that can be carried out to know if someone has had or has risk to have a ACV.  

When a ACV is suspected, the Computed Tomography  (CT) is the first exam to carry out, being able to confirm the ACV and to establish if it has been caused by a cerebral haemorrhage.  The Magnetic Resonance is another method of diagnosis that permits to know in a premature way the extension of the heart attack and to know the areas around the same one that run risk (half-light isquemica) and which still can be saved, minimizing thus the damage.  

Another method of diagnosis is the angiography which locates exactly the place of the blockage or of the bleeding and is utilized besides to guide fine catheters to the place of the problem and to administer the correspondent procedures. 

How can the ACV be prevented? 

The arteriosclerosis in the carotid artery  particularly, can produce a ACV either due to the decrease of blood flow, fragmentation of the plate or adhered coagulation and distal impact with occlusion of smaller cerebral vessels 

Angioplastia y colocacon de stent

Likewise the patients should:

• Stop smoking.
• Control the arterial pressure.
• Control the levels of cholesterol.
• Maintain an adequate weight.
• Carry out exercise.
• Utilize  appropriate medications prescripted by the doctor.
• Utilize appropriate prescript medications by the doctor with the aspirin,
  anticoagulants, etc.
• Be treated of the cardiac illness.
• Treat aneurysms or malformations arteriovenosas intracranial not broken
  and discovered by other symptoms or by coincidence.
  

How can the ACV be treated?

For those patients that are presented with possible ACV, it is important to determine first if it is a matter of an ischemic or hemorrhagic ACV.  For it the doctor makes use of the computed tomography.  If the ACV is ischemic (due to coagulation or plate) and the underlying wound is found in the carotid artery  or in another artery that goes to the brain, it will be able to be treated in order to avoid that a future ACV occurs.  

Besides it will be able, if clots exist occluding the arteries, to  administer drugs that dissolve the coagulation (trombolíticos as the Urokinasa) by endovenosa.  This technique should be carried out before the 3 hours since the start of the symptoms.  

When the therapy cannot be initiated inside the 3 hours or when the procedure by endovenosa after the 3 hours is not sufficient, the medicine can be administered directly in contact with the coagulation, what we call intrarterial trombolisis Fig. 1. 

Using X-rays the doctor (interventionist radiologist) inserts through a small incision in the groin, small catheters that rise to the ocluded artery  and then inject directly the medicine in proximity of the coagulation or  break into in a mechanical way.  This permits to administer these drugs 6 hours after the beginning of the symptoms minimizing thus the risk of secondary hemorrhage by using this medication since it uses less dose than by intravenous.  Its action would be quicker using a greater concentration of the drug in contact with the clot , besides the mechanical possibility to fragment it of form with the catheter , the guide or other at present available devices for this end.  

One of the many detrombectomia mechanical devices , is called Merci. .