Ferro J M, Correia M, Freire A
Serviço de Neurologia, Hospital de Santa Maria/Faculdade de Medicina de Lisboa.
Acta Med Port. 1998 Aug-Sep;11(8-9):791-812.
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.
本文介绍了根据现有科学证据分级制定的二级卒中预防指南。明确了卒中和短暂性脑缺血发作（TIA）的定义，并确定了转诊指征。卒中患者的基本评估应包括实验室检查、心电图、脑部CT、对颈动脉分布区事件进行颅外血管超声检查，以及在怀疑心源性栓塞时进行经胸或经食管超声心动图检查。二级卒中预防推荐的一般措施包括通过药物和非药物手段降低血压和血清胆固醇、戒烟、减少酒精摄入，以及进行更健康的生活方式改变（如采用地中海式饮食和定期进行适度体育锻炼）。关于抗栓治疗，对于心房颤动和其他具有高至中度栓塞性心脏风险状况的患者，推荐使用口服抗凝剂。对于所有其他缺血性脑事件幸存者，推荐使用抗血小板药物。阿司匹林（75 - 325毫克/天）是首选药物。替代抗血小板药物有氯吡格雷、噻氯匹定、双嘧达莫或曲氟尿苷。它们可用于对阿司匹林不耐受或有禁忌的患者或高危人群。对于有症状性颈动脉狭窄且症状性脑半球一侧颈动脉狭窄> 80%的缺血性卒中和TIA患者，推荐进行有症状颈动脉内膜切除术。
