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[Preventive treatment of cerebrovascular accidents of arterial origin]
V Castillo1, J Bogousslavsky, P Vuadens
1Conseil national de science et technologie du Mexique.
Insights
Platelet aggregation inhibitors like aspirin help prevent cerebrovascular insults (CVI). Carotid endarterectomy is effective for symptomatic stenosis but its use for asymptomatic cases remains debated.
Area of Science:
- Neurology
- Vascular Medicine
- Pharmacology
Context:
- Cerebrovascular insults (CVI) pose significant health risks.
- Platelet aggregation inhibitors are widely used for CVI prevention.
- Carotid endarterectomy is a surgical option for specific CVI risk reduction.
Purpose:
- To review current strategies for cerebrovascular insult (CVI) prevention.
- To evaluate the efficacy of platelet aggregation inhibitors and carotid endarterectomy.
- To discuss the role of aspirin, ticlopidine, clopidogrel, and carotid endarterectomy in CVI prevention.
Summary:
- Aspirin (250 +/- 100 mg/day) is a common regimen for high-risk patients.
- Aspirin and ticlopidine (500 mg/day) are recommended for secondary prevention of arterio-arterial CVI.
- Clopidogrel is being compared to aspirin for CVI prevention.
- Carotid endarterectomy significantly reduces stroke risk in symptomatic carotid stenosis (70-99%).
- The benefit of endarterectomy for asymptomatic stenosis is controversial.
Impact:
- Provides an overview of evidence-based CVI prevention methods.
- Highlights the established role of antiplatelet therapy and surgical intervention.
- Informs clinical decision-making regarding treatment for patients at risk of CVI.
- Suggests caution in the application of carotid endarterectomy for asymptomatic carotid stenosis.
Abstract:
Inhibitors of platelet aggregation are in use for prevention of cerebrovascular insults (CVI). Aspirin at a dose of 250 +/- 100 mg/day is the most common regimen for patients at an elevated risk for vascular complications. Aspirin and ticlopidine (500 mg/day) are the best drugs for secondary prevention of arterio-arterial cerebrovascular incidents. Efficacy of inhibitors of platelet aggregation in prevention of primary cerebral infarcts has not been demonstrated. An analogue of ticlopidine, clopidogrel is presently under comparison with aspirin in the prevention of CVI. Endarterectomy of the carotid has been evaluated in several studies for prevention of CVI. In patients with symptomatic carotid stenosis (70 to 99%), endarterectomy decreases the risk for cerebral infarcts by 20 to 44%. The indication for endarterectomy in patients with asymptomatic stenosis has to be posed reluctantly because of controversial interpretations of recent study results.