[Preventive treatment of cerebrovascular accidents of arterial origin]

Abstract

Inhibitors of platelet aggregation are in use for prevention of cerebrovascular insults (CVI). Aspirin at a dose of 250 +/- 100 mg/day is the most common regimen for patients at an elevated risk for vascular complications. Aspirin and ticlopidine (500 mg/day) are the best drugs for secondary prevention of arterio-arterial cerebrovascular incidents. Efficacy of inhibitors of platelet aggregation in prevention of primary cerebral infarcts has not been demonstrated. An analogue of ticlopidine, clopidogrel is presently under comparison with aspirin in the prevention of CVI. Endarterectomy of the carotid has been evaluated in several studies for prevention of CVI. In patients with symptomatic carotid stenosis (70 to 99%), endarterectomy decreases the risk for cerebral infarcts by 20 to 44%. The indication for endarterectomy in patients with asymptomatic stenosis has to be posed reluctantly because of controversial interpretations of recent study results.