缺血性脑卒中预防研究进展

Progress in Prevention of Cerebral Ischemic Stroke

最近有关营养、控制血压、抗血小板、抗凝治疗、识别高危无症状性颈动脉狭窄以及经皮封堵卵圆孔未闭(PFO)预防卒中取得明显进步,证据表明地中海饮食和B族维生素可预防卒中,以肾素和醛固酮表型为基础的个体化治疗可明显改善血压控制,CYP2D19突变影响氯吡格雷的活化且限制其疗效。新型抗凝剂较阿司匹林出血少见且无需对房颤(AF)长期监测,明显改善对心源性脑卒中的预防。经颅多普勒(TCD)是监测微栓子的有效方法,经皮封堵PFO证明有效,可通过临床线索鉴别反常性栓塞以及TCD对分流的分级评估。

Recent advances in nutrition,blood pressure control,antiplatelet therapy,anticoagulant therapy,identification of high-risk asymptomatic carotid stenosis,and percutaneous closure of patent foramen ovale(PFO)have shown significant progress,evidence suggests that the Mediterranean diet and the B family Vitamins prevent stroke,and individualized treatment based on renin and aldosterone phenotypes can significantly improve blood pressure control.CYP2D19 mutations affect clopidogrel activation and limit its efficacy.New anticoagulants are less common than aspirin and do not require long-term monitoring of atrial fibrillation(AF),significantly improving the prevention of cardiogenic stroke.Transcranial Doppler(TCD)is an effective method for monitoring microemboli.Percutaneous closure of PFO is effective,and clinical cues can be used to identify abnormal embolism and TCD for grading assessment of shunt.