Skip to main content Accessibility help
×
Home
Hostname: page-component-55597f9d44-pgkvd Total loading time: 0.719 Render date: 2022-08-10T09:41:07.418Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "useNewApi": true } hasContentIssue true

Chapter 8 - Ischemic Stroke Etiology and Secondary Prevention

Published online by Cambridge University Press:  28 October 2019

Mary Carter Denny
Affiliation:
Georgetown University Hospital
Ahmad Riad Ramadan
Affiliation:
Henry Ford Hospital, Detroit
Sean I. Savitz
Affiliation:
University of Texas Health Science Center, Houston
James Grotta
Affiliation:
Memorial Hermann Texas Medical School
Get access

Summary

In this chapter, we discuss mainly secondary prevention for stroke, although many of the measures, especially control of risk factors and lifestyle changes such as not smoking, controlling blood pressure, etc., are also important measures to avoid a first stroke.

Initially, we discuss a tailored diagnostic work-up, then general measures for secondary prevention of ischemic stroke, and finally recommendations for specific conditions that are associated with a high risk of recurrent stroke.

Type
Chapter
Information
Acute Stroke Care , pp. 119 - 152
Publisher: Cambridge University Press
Print publication year: 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Chobanian, AV, Bakris, GL, Black, HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289: 25602572.CrossRefGoogle ScholarPubMed
SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265: 32553264.CrossRef
Yusuf, S, Sleight, P, Pogue, J, et al.; Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000; 342: 145153.Google ScholarPubMed
PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet 2001; 358: 10331041.CrossRef
ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288: 29812997.CrossRef
Dahlof, B, Devereux, RB, Kjeldsen, SE, et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 9951003.CrossRefGoogle ScholarPubMed
Psaty, BM, Lumley, T, Furberg, CD, et al. Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis. JAMA 2003; 289: 25342544.CrossRefGoogle ScholarPubMed
Whelton, PK, Carey, RM, Aronow, WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2018; 138: e426e483. doi:10.1161/CIR.0000000000000597.Google Scholar
Wright, JT, Williamson, JD, Whelton, PK, et al. A randomized trial of intensive versus standard blood‐pressure control. N Engl J Med 2015; 373: 21032116.Google ScholarPubMed
Grundy, SM, Stone, NJ, Bailey, AL, et al. AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol. A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 139: e1046–e1081. doi:10.1161/CIR.0000000000000625.CrossRef
Amarenco, P, Bogousslavsky, J, Callahan, A, et al.; Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators.High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med 2006; 355: 549559.Google ScholarPubMed
Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo-controlled trial. Lancet 2002; 360: 722.CrossRef
Powers, WJ, Rabinstein, AA, Ackerson, T, et al.; American Heart Association Stroke Council. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018; 49: e46e110. doi:10.1161/STR.0000000000000158.CrossRefGoogle ScholarPubMed
Bruno, A, Durkalski, VL, Hall, CE, et al. The Stroke Hyperglycemia Insulin Network Effort (SHINE) trial protocol: a randomized, blinded, efficacy trial of standard vs. intensive hyperglycemia management in acute stroke. Int J Stroke 2014; 9: 246251. doi:10.1111/ijs.12045.CrossRefGoogle ScholarPubMed
Kernan, WN, Viscoli, CM, Furie, KL, et al. Pioglitazone after ischemic stroke or transient ischemic attack. N Engl J Med 2016; 374: 13211331. doi:10.1056/NEJMoa1506930.CrossRefGoogle ScholarPubMed
Estruch, R, Ros, E, Salas-Salvadó, J, et al.; PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013; 368: 12791290. Corrected and republished in: N Engl J Med 2018; 378: e34.CrossRefGoogle ScholarPubMed
Viscoli, CM, Brass, LM, Kernan, WN, et al. A clinical trial of estrogen replacement therapy after ischemic stroke. N Engl J Med 2001; 345: 12431249.CrossRefGoogle ScholarPubMed
Anderson, GL, Limacher, M, Assaf, AR, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. JAMA 2004; 291: 17011712.Google ScholarPubMed
Rossouw, JE, Anderson, GL, Prentice, RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002; 288: 321333.Google ScholarPubMed
Antiplatelet Trialists’ Collaboration. Collaborative overview of randomised trials of antiplatelet therapy. I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ 1994; 308: 81106.CrossRef
Diener, HC, Cunha, L, Forbes, C, et al. European Stroke Prevention Study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci 1996; 143: 113.CrossRefGoogle ScholarPubMed
ESPS Group. The European Stroke Prevention Study (ESPS): principal end-points. Lancet 1987; 2: 13511354.
Sacco, RL, Diener, HC, Yusuf, S, et al.; PRoFESS Study Group. Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke. N Engl J Med 2008; 359: 12381251.CrossRefGoogle ScholarPubMed
Johnston, SC, Amarenco, P, Albers, GW, et al. Ticagrelor versus aspirin in acute stroke or transient ischemic attack. N Engl J Med 2016; 375: 3543. doi:10.1056/NEJMoa1603060.CrossRefGoogle ScholarPubMed
Amarenco, P, Albers, GW, Denison, H, et al. Efficacy and safety of ticagrelor versus aspirin in acute stroke or transient ischaemic attack of atherosclerotic origin: a subgroup analysis of SOCRATES, a randomised, double-blind, controlled trial. Lancet Neurol 2017; 16: 301310. doi:10.1016/S1474-4422(17)30038-8.CrossRefGoogle ScholarPubMed
Dinicolantonio, JJ, Lavie, CJ, Fares, H, et al. Meta-analysis of cilostazol versus aspirin for the secondary prevention of stroke. Am J Cardiol 2013; 112: 12301234. doi:10.1016/j.amjcard.2013.05.067.CrossRefGoogle ScholarPubMed
Costa, J, Ferro, JM, Matias-Guiu, J, Álvarez-Sabín, J, Torres, F. Triflusal for preventing serious vascular events in people at high risk. Cochrane Database Syst Rev 2005; (3): CD004296.Google ScholarPubMed
Chimowitz, MI, Lynn, MJ, Derdeyn, CP, et al.; SAMMPRIS Trial Investigators. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 2011; 365: 9931003.CrossRefGoogle ScholarPubMed
Wang, Y, Wang, Y, Zhao, X, et al.; CHANCE Investigators. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med 2013; 369: 1119. doi:10.1056/NEJMoa1215340.CrossRefGoogle ScholarPubMed
Johnston, SC, Easton, JD, Farrant, M, et al. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA. N Engl J Med 2018; 379: 215225. doi:10.1056/NEJMoa1800410.CrossRefGoogle ScholarPubMed
Benavente, OR, Hart, RG, McClure, LA, et al.; SPS3 Investigators. Effects of clopidogrel added to aspirin in patients with recent lacunar stroke. N Engl J Med 2012; 367: 817825. doi:10.1056/NEJMoa1204133.Google ScholarPubMed
Diener, HC, Bogousslavsky, J, Brass, LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet 2004; 364: 331337.CrossRefGoogle ScholarPubMed
Bhatt, DL, Fox, KA, Hacke, W, et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med 2006; 354: 17061717.CrossRefGoogle ScholarPubMed
van Es, N, Coppens, M, Schulman, S, et al. Direct oral anticoagulants compared with vitamin K antagonists for acute venous thromboembolism: evidence from phase 3 trials. Blood 2014; 124: 19681975. doi:10.1182/blood-2014-04-571232.CrossRefGoogle ScholarPubMed
Choe, WC, Passman, RS, Brachmann, J, et al. A comparison of atrial fibrillation monitoring strategies after cryptogenic stroke (from the Cryptogenic Stroke and Underlying AF Trial). Am J Cardiol 2015; 116: 889893. doi:10.1016/j.amjcard.2015.06.012.CrossRefGoogle Scholar
Sanna, T, Diener, HC, Passman, RS, et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med 2014; 370: 24782486.CrossRefGoogle ScholarPubMed
Gladstone, DJ, Spring, M, Dorian, P, et al. Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med 2014; 370: 24672477.CrossRefGoogle ScholarPubMed
Reddy, VY, Doshi, SK, Kar, S, et al. 5-year outcomes after left atrial appendage closure: from the PREVAIL and PROTECT AF trials. J Am Coll Cardiol 2017; 70: 29642975. doi:10.1016/j.jacc.2017.10.021.CrossRefGoogle ScholarPubMed
Barnett, HJ, Taylor, DW, Eliasziw, M, et al.; North American Symptomatic Carotid Endarterectomy Trial Collaborators. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. N Engl J Med 1998; 339: 14151425.CrossRefGoogle ScholarPubMed
Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA 1995; 273: 14211428.CrossRef
Halliday, A, Mansfield, A, Marro, J, et al.; MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet 2004; 363: 14911502.Google ScholarPubMed
Brott, TG, Hobson, RW, Howard, G, et al.; CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 2010; 363: 1123.CrossRefGoogle ScholarPubMed
Rosenfield, K, Matsumura, JS, Chaturvedi, S, et al. Randomized trial of stent versus surgery for asymptomatic carotid stenosis. N Engl J Med 2016; 374: 10111020. doi:10.1056/NEJMoa1515706.CrossRefGoogle ScholarPubMed
Rothwell, PM, Eliasziw, M, Gutnikov, SA, et al. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 2004; 363: 915924.CrossRefGoogle ScholarPubMed
Rothwell, PM, Eliasziw, M, Gutnikov, SA, et al. Sex difference in the effect of time from symptoms to surgery on benefit from carotid endarterectomy for transient ischemic attack and nondisabling stroke. Stroke 2004; 35: 28552861.CrossRefGoogle ScholarPubMed
Grubb, RL, Powers, WJ, Derdeyn, CP, et al. The carotid occlusion surgery study. Neurosurg Focus 2003; 14 (3): e9.CrossRefGoogle ScholarPubMed
Chimowitz, MI, Lynn, MJ, Howlett-Smith, H, et al.; Warfarin-Aspirin Symptomatic Intracranial Disease Trial Investigators. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 2005; 352: 13051316.CrossRefGoogle ScholarPubMed
Yonemura, K, Kimura, K, Minematsu, K, et al. Small centrum ovale infarcts on diffusion-weighted magnetic resonance imaging. Stroke 2002; 33: 15411544.CrossRefGoogle ScholarPubMed
Vahidy, FS, Hicks, WJ, Acosta, I, et al. Neurofluctuation in patients with subcortical ischemic stroke. Neurology 2014; 83: 398405. doi:10.1212/WNL.0000000000000643.CrossRefGoogle ScholarPubMed
Markus, HS, Hayter, E, Levi, C, et al. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. CADISS trial investigators. Lancet Neurol 2015; 14: 361367. doi:10.1016/S1474-4422(15)70018-9. Erratum in: Lancet Neurol 2015; 14: 566.Google Scholar
Touze, E, Gauvrit, JY, Moulin, T, et al. Risk of stroke and recurrent dissection after a cervical artery dissection: a multicenter study. Neurology 2003; 61: 13471351.CrossRefGoogle ScholarPubMed
Overell, JR, Bone, I, Lees, KR. Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies. Neurology 2000; 55: 11721179.CrossRefGoogle ScholarPubMed
Mas, JL, Derumeaux, G, Guillon, B, et al.; CLOSE Investigators. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med 2017; 377: 10111021. doi:10.1056/NEJMoa1705915.CrossRefGoogle ScholarPubMed
Saver, JL, Carroll, JD, Thaler, DE, et al.; RESPECT Investigators. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med 2017; 377: 10221032. doi:10.1056/NEJMoa1610057.CrossRefGoogle ScholarPubMed
Søndergaard, L, Kasner, SE, Rhodes, JF, et al.; Gore REDUCE Clinical Study Investigators. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med 2017; 377: 10331042. doi:10.1056/NEJMoa1707404.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×