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KMID : 0858420090110020067
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Korean Journal of Stroke
2009 Volume.11 No. 2 p.67 ~ p.72
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Stroke update 2009: Secondary Stroke Prevention
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Lee Yong-Seok
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Abstract
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In The Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial, recurrent stroke occurred in 9.0% receiving aspirin and extended-release dipyridamole (ASA-ERDP) and in 8.8% receiving clopidogrel [hazard ratio (HR) 1.01; 95% confidence interval (CI) 0.92 to 1.11]. There were more major hemorrhagic events among ASA-ERDP group (4.1% vs. 3.6%, P<0.05). Therapy with telmisartan did not significantly lower the rate of recurrent stroke, major cardiovascular events, or diabetes in spite of blood pressure (BP) lowering. In The Cilostazol versus Aspirin for Secondary Ischaemic Stroke Prevention (CASISP) trial comparing cilostazol with aspirin in patients with ischemic stroke, cilostazol showed non-significant trend to prevent recurrent stroke (HR 0.62; 95% CI 0.30-1.26). Symptomatic and aymptomatic hemorrhage was less frequent in cilostazol group. Three-year follow-up of The Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial showed that there was no difference between carotid artery stenting group and endarterectomy group. Two to four-year follow-up study of The Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) and Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial, in which patients with symptomatic carotid stenosis were included, also showed no difference of cardiovascular events including stroke. These results suggested that mid or long-term outcome is comparable between stenting and endarterectomy. Meta-analysis from 8,832 patients with statin therapy showed decreased incidence of recurrent ischemic stroke [relative risk (RR) 0.80; 95% CI 0.70-0.92], while increased risk of hemorrhagic stroke (RR 1.73; 95% CI 1.19-2.50) in statin group. Post-hoc analysis of Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study revealed that hemorrhagic stroke as an entry event, age, hypertension, ator-vastatin per se, and small vessel disease subtype increase the risk of intracerebral hemorrhage
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KEYWORD
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Stroke, Recurrent stroke, Secondary prevention, Antiplatelet agents, Carotid stenosis, Intracerebral hemorrhage
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