Related Experiment Videos
Prophylaxis and acute therapy of arterial embolism with special reference to cerebral embolism
B Tettenborn1, G Krämer, R Erbel
1Department of Neurology, University Hospital Mainz.
Insights
Acetylsalicylic acid effectively prevents stroke in patients with artery-to-artery embolism. Anticoagulation is recommended for specific high-risk cases, but treatment for non-rheumatic atrial fibrillation remains uncertain.
Area of Science:
- Neurology
- Vascular Medicine
- Cardiology
Background:
- Arterial embolism poses risks for stroke and systemic embolism.
- Cerebral ischemia often results from atheromatous plaques or cardiac sources.
- Current prevention strategies vary, with ongoing research into antiplatelet and anticoagulant therapies.
Purpose of the Study:
- To review current prophylaxis and treatment strategies for arterial embolism.
- To evaluate the efficacy of antiplatelet drugs and anticoagulation in preventing stroke and systemic embolism.
- To identify therapeutic dilemmas in managing patients with specific cardiovascular conditions.
Main Methods:
- Review of existing clinical data and multicenter studies.
- Analysis of the effectiveness of acetylsalicylic acid for secondary stroke prevention.
- Assessment of recommendations for anticoagulation in various high-risk scenarios.
Main Results:
- Acetylsalicylic acid (300 mg/day) is effective for secondary stroke prevention in artery-to-artery embolism.
- Carotid endarterectomy benefits patients with high-grade carotid stenosis.
- Anticoagulation is recommended for recurrent TIAs, progressing stroke, cardiac embolism, and specific atrial fibrillation cases.
Conclusions:
- Acetylsalicylic acid demonstrates efficacy in secondary stroke prevention for specific embolism types.
- Anticoagulation offers benefits in several high-risk clinical situations.
- Optimal prevention strategies for non-rheumatic atrial fibrillation require further investigation.
Abstract:
Prophylaxis and treatment of arterial embolism in high-risk patients includes therapy with antiplatelet drugs, anticoagulation, and vascular surgery. The prominent causes of cerebral ischemia are intraarterial emboli from atheromatous plaques and cardiac emboli. In patients with recent hemispheric transient ischemic attacks or minor stroke and ipsilateral high-grade internal carotid artery stenosis of 70 to 99% carotid endarterectomy has shown to be effective in prevention of major stroke or death. In the majority of patients with moderate atherosclerotic disease of the extracranial arteries as well as in patients with a cardiac source of emboli, no generally excepted therapy for primary and secondary prevention of cerebral ischemia or systemic embolism exists. The efficacy of antiplatelet drugs and anticoagulants in these patients is still investigated in a number of clinical multicenter studies. From the presently available data one can conclude that the antiplatelet agent acetylsalicylic acid in a dosage of 300 mg per day is effective in the secondary prevention of stroke and death in patients with preceding transient ischemic attacks, minor or major stroke and suspected artery-to-artery embolism from mild to moderate atherothrombotic carotid and vertebral artery disease. If there are no contraindications, we recommend anticoagulation in recurrent transient ischemic attacks not responding to antiplatelet drugs, in progressing stroke especially in the vertebrobasilar territory, in transient ischemic attacks in patients with rheumatic atrial fibrillation and left atrium thrombi, in minor stroke and proven cardiac embolism, in cerebral ischemia due to traumatic large vessel disease, and before and following elective cardioversion in patients with long-standing atrial fibrillation. A therapeutic dilemma still exists in patients with nonrheumatic atrial fibrillation; the presently available data are not sufficient to give recommendations whether aspirin or anticoagulants should be given for primary and secondary prevention of stroke and systemic embolism in these patients.