Related Experiment Videos
[Therapeutic recommendations. Secondary prevention of cerebral vascular accident]
J M Ferro1, M Correia, A Freire
1Serviço de Neurologia, Hospital de Santa Maria/Faculdade de Medicina de Lisboa.
Insights
These guidelines offer evidence-based strategies for secondary stroke prevention, including lifestyle changes, antithrombotic therapy, and surgical options. They cover assessment, risk factor modification, and specific treatments for stroke and TIA survivors.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Context:
- Stroke and transient ischemic attack (TIA) represent significant public health challenges.
- Effective secondary prevention is crucial to reduce recurrence and improve patient outcomes.
Purpose:
- To present graded guidelines for secondary stroke prevention based on current scientific evidence.
- To define stroke and TIA and establish indications for patient referral.
Summary:
- Guidelines recommend comprehensive assessment including laboratory tests, ECG, brain imaging, and vascular/cardiac imaging.
- General measures include blood pressure and cholesterol management, smoking cessation, reduced alcohol intake, healthy diet, and exercise.
- Antithrombotic therapy involves oral anticoagulants for high-risk cardiac conditions and antiplatelet agents (aspirin, clopidogrel, etc.) for ischemic event survivors.
- Carotid endarterectomy is indicated for symptomatic carotid stenosis >80%.
Impact:
- Provides a framework for clinicians to manage patients at risk of recurrent stroke.
- Aims to standardize and improve the quality of secondary stroke prevention strategies.
- Contributes to reducing stroke morbidity and mortality through evidence-based interventions.
Abstract:
The guidelines for secondary stroke prevention, graded following available scientific evidence, are presented. Stroke and TIA are defined and the indications for referral established. Basic assessment of stroke patients should include laboratory evaluation, ECG, brain CT, ultrasound examination of the extracranial vessels for events in the carotid distribution, and transthoracic or transesophageal echocardiogram if cardioembolism is suspected. The pharmacological and non-pharmacological reduction of blood pressure and serum cholesterol, stopping smoking and reducing alcohol intake are general measures recommended for secondary stroke prevention, together with healthier life-style changes (eating a Mediterranean type diet and performing regular moderate physical exercise). Concerning antithrombotic therapy, oral anticoagulants are recommended for patients with atrial fibrillation and other high to medium emboligenic cardiac risk conditions. Antiplatelet drugs are recommended for all other survivors of an ischemic cerebral event. Aspirin (75-325 mg/day) is the drug of choice. Alternative antiplatelet agents are clopidrogrel, ticlopidine, dipiridamol or triflusal. They can be used in patients with intolerance or contraindication to aspirin or in high-risk subjects. Endarterectomy of the symptomatic carotid is an additional procedure recommended for patients with ischemic stroke or TIA and carotid stenosis > 80% on the side of the symptomatic cerebral hemisphere.