Castillo V, Bogousslavsky J, Vuadens P
Conseil national de science et technologie du Mexique.
Praxis (Bern 1994). 1996 Feb 6;85(6):159-63.
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.
血小板聚集抑制剂用于预防脑血管损伤（CVI）。对于血管并发症风险较高的患者，最常用的方案是每天服用250±100毫克阿司匹林。阿司匹林和噻氯匹定（每天500毫克）是预防动脉-动脉性脑血管事件二级预防的最佳药物。血小板聚集抑制剂在预防原发性脑梗死方面的疗效尚未得到证实。噻氯匹定的类似物氯吡格雷目前正在与阿司匹林进行预防CVI的比较。多项研究对颈动脉内膜切除术预防CVI进行了评估。对于有症状的颈动脉狭窄（70%至99%）患者，内膜切除术可将脑梗死风险降低20%至44%。由于对近期研究结果的解释存在争议，对于无症状狭窄患者进行内膜切除术的指征必须谨慎提出。
