Medical Treatment of Intracranial Atherosclerosis: An Update / 대한뇌졸중학회지
Journal of Stroke
;
: 261-270, 2017.
Artículo
en Inglés
| WPRIM
| ID: wpr-51274
ABSTRACT
For patients with symptomatic intracranial atherosclerosis (ICAS), antithrombotic agents are the mainstay of therapy. Anticoagulation (warfarin) is not widely used since it is not more effective than aspirin and carries a high risk of bleeding. New oral anticoagulants are showing promise, but their use has not been investigated in appropriate clinical trials. Since the recurrent stroke risk is high with aspirin monotherapy, dual antiplatelets are considered in the early stage of symptomatic ICAS. Based on the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) and Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) results, aspirin plus clopidogrel has been recommended. However, this combination was not superior to aspirin monotherapy in patients with ICAS in the CHANCE substudy. Progression of ICAS is common, and it is associated with recurrent strokes. In the Trial of Cilostazol in Symptomatic Intracranial Arterial Stenosis (TOSS) study, aspirin plus cilostazol was more effective than aspirin monotherapy in preventing progression. The TOSS II trial showed that the overall change in stenosis was better with aspirin plus cilostazol than with aspirin plus clopidogrel. Aside from antithrombotic therapy, risk factor management is critical for secondary prevention, and high blood pressure is clearly linked to recurrent stroke. However, blood pressure may have to be cautiously managed in the early stage of stroke. Considering that ICAS is the major cause of stroke worldwide, further investigations are needed to establish optimal management strategies for patients with ICAS.
Texto completo:
Disponible
Índice:
WPRIM (Pacífico Occidental)
Asunto principal:
Presión Sanguínea
/
Stents
/
Arteriosclerosis Intracraneal
/
Aspirina
/
Factores de Riesgo
/
Constricción Patológica
/
Inhibidores de Hidroximetilglutaril-CoA Reductasas
/
Accidente Cerebrovascular
/
Prevención Secundaria
/
Fibrinolíticos
Tipo de estudio:
Estudio de etiología
/
Factores de riesgo
Límite:
Humanos
Idioma:
Inglés
Revista:
Journal of Stroke
Año:
2017
Tipo del documento:
Artículo
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