Prevention of ischemic stroke


Authors: MUDr. Daniel Václavík
Authors‘ workplace: Neurologické oddělení a Iktové centrum ;  Vítkovická nemocnice a. s. daniel. vaclavik@nemvitkovice. cz
Published in: Kardiol Rev Int Med 2013, 15(1): 37-40
Category:

Overview

Treatment of general vascular risk factors (hypertension, diabetes mellitus, hypercholesterolemia) is necessary in primary and secondary prevention of stroke. The most important non-pharmacological approaches are quitting smoking, limited consumption of alcohol, diet containg unsaturated fat, rich in fruits and vegetables, weight reduction and physical exercise. Patients with atrial fibrillation with high risk of embolisation are recommended for anticoagulation treatment with warfarin or direct inhibitors of thrombin or factor X. The men with severe 70% stenosis are recommended for carotid endarterectomy in primary prevention if the perioperative morbidity and mortality risk is estimated to be < 3%. The other patients with carotid artery stenosis are recommended to antiagregation therapy. Patients with cardiogenic stroke are recommended for anticoagulation therapy and those with non cardiogenic stroke for antiagregation therapy. For patients with ischemic stroke and ipsilateral carotid artery stenosis above 70%, carotid endarterectomy is recommended if the perioperative morbidity and mortality risk is estimated to be < 6%.

Keywords:
prevention – vascular risk factors – anticoagulation – endartectomy and stenting


Sources

1. The European Stroke Organisation (ESO) Executive Committee and the ESO Writing Committee. Ringleb PA, Bousser MG, Ford G et al. Management ischemické cévní mozkové příhody a tranzitorní ischemické ataky – doporučení European Stroke Organisation (ESO) 2008, aktualizace leden 2009; 19–31.

2. European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm AJ, Kirchhof P, Lip GY et al. ESC Committee for Practice Guidelines. Guidelines for the management of atrial fibrillation: the Task Force forthe Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace 2010; 12: 1360–1420.

3. Furie KL, Kasner SE, Adams RJ et al. American Heart Association Stroke Council, Council on Cardio­vascular Nursing, Council on Clinical Cardiology, and Interdisciplinary Council on Quality of Care and Outcomes Research. Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals From the American Heart Association//American Stroke Association. Stroke 2011; 42: 227–276.

4. Ahmad Y, Lip GY. Stroke Prevention in Atrial Fibrillation: Where are We Now? Clin Med Insights Cardiol 2012; 6: 65–78.

5. Kizer JR, Dahlöf B, Kjeldsen Seet al. Stroke reduction in hypertensive adults with cardiac hypertrophy randomized to losartan versus atenolol: the Losartan Intervention For Endpoint reduction in hypertension study. Hypertension 2005; 45: 46–52.

6. He K, Song Y, Daviglus M et al. Fish consumption and incidence of stroke: A meta-analysis of cohort studies. Stroke 2004; 35: 1538–1515.

7. Ridker PM, Cook NR, Lee IM et al. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med 2005; 352: 1293–1304.

8. Wilcox R, Bousser MG, Betteridge DJ et al. PROactive Investigators. Effects of pioglitazone in patients with type 2 diabetes with or without previous stroke: results from PROactive (PROspective pioglitAzone Clinical Trial In macroVascular Events 04). Stroke 2007; 38: 865–873.

9. Amarenco P, Bogousslavsky J, Callahan A et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med 2006; 355: 549–559.

10. Rothwell PM, Eliasziw M, Gutnikov SA. Carotid Endarterectomy Trialists Collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 2004; 363: 915–924.

Labels
Paediatric cardiology Internal medicine Cardiac surgery Cardiology
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