Related Experiment Videos
[Large trials in the secondary prevention of stroke]
G F Gensini1, I Simone, L Pantoni
1Istituto di Clinica Medica Generale e Cardiologia, Università degli Studi di Firenze.
Insights
Effective stroke prevention strategies are crucial as no drug treats acute ischemic stroke. Secondary prevention includes medical and surgical therapies, with specific treatments depending on carotid stenosis severity and stroke type.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Preventive Medicine
Context:
- Acute ischemic stroke lacks effective drug treatments, highlighting the importance of prevention.
- Secondary stroke prevention strategies have proven efficacy through medical and surgical interventions.
- Risk factor control is fundamental in managing stroke risk.
Purpose:
- To review current strategies for the primary and secondary prevention of ischemic stroke.
- To outline treatment choices based on carotid stenosis and stroke etiology.
- To discuss the role of antiplatelet and anticoagulant therapies.
Summary:
- Surgical endarterectomy is preferred for >70% carotid stenosis in atherothrombotic TIA/minor stroke.
- Antiplatelet agents, particularly aspirin, are standard for <70% stenosis.
- Newer evidence supports dipyridamole-aspirin combination over low-dose aspirin for secondary prevention.
Impact:
- Informs clinical decision-making for stroke prevention.
- Highlights the efficacy of established and emerging therapies.
- Emphasizes individualized treatment approaches based on patient-specific factors.
Abstract:
To date, no drug has been demonstrated as efficacious in the treatment of acute ischemic stroke. Therefore, primary and secondary prevention play a fundamental role. Besides adequate control of risk factors, trials and meta-analyses have demonstrated that both medical and surgical therapy are effective in secondary prevention of stroke. In patients with atherothrombotic transient ischemic attack (TIA) or minor stroke and carotid stenosis > 70%, surgical therapy (endarterectomy) is the treatment of choice, while antiplatelet drugs are the elective treatment in the case of stenosis < 70%. Acetylsalicylic acid is the first choice medical treatment, but the optimal dosage is still a matter of debate. Ticlopidine has an efficacy similar to that of aspirin, but shows a certain number of side effects; recently a European study has shown the efficacy of dipyridamole, and the superiority of the combination dipyridamole-aspirin vs low-dose aspirin. In the secondary prevention of cardioembolic stroke, oral anticoagulants have higher efficacy than antiplatelet drugs, at least in selected groups of patients.