缺血性卒中二级预防新指南的新思路和新启发

New ideas and inspiration of the updated guidelines for secondary prevention of ischemic stroke

随着研究证据的不断积累,缺血性卒中二级预防指南也在不断更新。美国心脏协会/美国卒中协会2014年脑卒中二级预防指南更加强调普适性和临床相关性,同时更加针对特定的临床情况,如动脉粥样硬化性卒中注重他汀类药物调脂治疗和抗栓治疗;小血管病性卒中强调降压治疗;心源性栓塞,新型口服抗凝药疗效优于华法林;颅内动脉粥样硬化性狭窄,积极的药物治疗优于血管内介入治疗。而降低血浆同型半胱氨酸水平和对无症状性颈动脉狭窄人群进行筛查仍缺乏高级别的证据支持。

Guidelines for secondary prevention of ischemic stroke had been updated recently as more and more evidences emerged.These updated guidelines emphasize more on the universality and clinical relevance.For example,intensified statin therapy and aggressive anti-platelet therapy are important for atherosclerotic stroke,while aggressive anti- hypertension therapy is the most important treatment for stroke caused by cerebral small vessel diseases.For prevention of cardioembolic stroke,new oral anticoagulants(NOACs) are more effective and safer than warfarin.In patients with intracranial atherosclerotic stenosis,intensified medication therapy is superior to endovascular intervention.Because of lacking evidences,the routine screening of carotid stenosis in asymptomatic adults and treating hyperhomocysteinemia are not recommended.