nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2023-3-4-10nnp-2022Research ArticleLECTURESЛЕКЦИЯPatient with non-cardioembolic ischemic stroke or high-risk transient ischemic attack. Part 2. Secondary prophylaxisПациент с некардиоэмболическим ишемическим инсультом или транзиторной ишемической атакой высокого риска. Часть 2. Вторичная профилактикаhttps://orcid.org/0000-0001-6061-8118КулешА. А.KuleshA. A.

Алексей Александрович Кулеш

614990, Пермь, ул. Петропавловская, 26

Alexey Alexandrovich Kulesh

26, Petropavlovskaya St., Perm 614990

aleksey.kulesh@gmail.comhttps://orcid.org/0000-0002-6484-286XЯнишевскийС. Н.YanishevskyS. N.

197341, Санкт-Петербург, ул. Аккуратова, 2

2, Akkuratova St., St. Petersburg 197341

https://orcid.org/0000-0003-2670-4172ДеминД. А.DeminD. A.

414004, Астрахань, ул. Покровская Роща, 4

4, Pokrovskaya Roshcha St., Astrakhan 414011

https://orcid.org/0000-0002-8305-1115СыромятниковаЛ. И.SyromyatnikovaL. I.

614990, Пермь, ул. Петропавловская, 26

26, Petropavlovskaya St., Perm 614990

https://orcid.org/0000-0002-3847-9366ВиноградовО. И.VinogradovO. I.

105203, Москва, ул. Нижняя Первомайская, 70

70, Nizhnyaya Pervomayskaya St., Moscow 105203

ФГБОУ ВО «Пермский государственный медицинский университет им. акад. Е.А. Вагнера» Минздрава РоссииРоссияAcad. E.A. Vagner Perm State Medical University, Ministry of Health of RussiaRussian FederationФГБУ «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава РоссииРоссияCity Clinical Hospital Four, Perm; 2Almazov National Medical Research Center, Ministry of Health of the RussiaRussian FederationФГБУ «Федеральный центр сердечно-сосудистой хирургии» Минздрава РоссииРоссияFederal Center for Cardiovascular Surgery, Ministry of Health of RussiaRussian FederationФГБУ «Национальный медико-хирургический центр им. Н.И. Пирогова» Минздрава РоссииРоссияN.I. Pirogov National Medical and Surgical Center, Ministry of Health of RussiaRussian Federation202303072023153410Copyright © Kulesh A.A., Yanishevsky S.N., Demin D.A., Syromyatnikova L.I., Vinogradov O.I., 20232023Кулеш А.А., Янишевский С.Н., Демин Д.А., Сыромятникова Л.И., Виноградов О.И.Kulesh A.A., Yanishevsky S.N., Demin D.A., Syromyatnikova L.I., Vinogradov O.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/2022

Non-cardioembolic ischemic stroke (IS) of high and very high risk includes three groups of patients: with severe extracranial atherosclerosis, with any intracranial atherosclerosis, and with aortic arch atheromatosis. This risk is also characteristic of patients with aggressive transient ischemic attack (TIA) phenotypes. Effectiveness of secondary prophylaxis can be raised by these strategies: short-term dual antiplatelet therapy using a combination of acetylsalicylic acid with clopidogrel or ticagrelor in minor IS or high-risk TIA; long-term dual antithrombotic therapy with acetylsalicylic acid and low doses of rivaroxaban for multifocal atherosclerosis with low hemorrhagic risk and non-lacunar stroke; early surgical revascularization (carotid endarterectomy or stenting) for non-disabling IS and urgent revascularization for high-risk TIA; intensive, including combined, lipid-lowering therapy with high doses of statins, ezetimibe, PCSK9 inhibitors, or inclisiran to achieve low-density lipoprotein levels <1.4 mmol/L ; antidiabetic therapy using type 2 glucose-sodium cotransporter inhibitors and type 1 glucagon-like peptide agonists with glycosylated hemoglobin level of <7%; prescribing antihypertensive therapy and achieving target blood pressure level.

Некардиоэмболический ишемический инсульт (ИИ) высокого и очень высокого риска включает в себя три группы пациентов: с тяжелым экстракраниальным атеросклерозом, с любым интракраниальным атеросклерозом, а также с атероматозом дуги аорты. Данный риск характерен также для пациентов с агрессивными фенотипами транзиторной ишемической атаки (ТИА). К стратегиям повышения эффективности вторичной профилактики можно отнести следующие: краткосрочная двойная антитромбоцитарная терапия с применением комбинации ацетилсалициловой кислоты с клопидогрелом или тикагрелором при малом ИИ или ТИА высокого риска; долгосрочная двойная антитромботическая терапия сприменением ацетилсалициловой кислоты инизких доз ривароксабана при мультифокальном атеросклерозе с низким геморрагическим риском и нелакунарном инсульте; ранняя хирургическая реваскуляризация (каротидная эндартерэктомия или стентирование) при неинвалидизирующем ИИ иургентная реваскуляризация при ТИА высокого риска; интенсивная, в том числе комбинированная, гиполипидемическая терапия с применением высоких доз статинов, эзетимиба, ингибиторов PCSK9 или инклисирана для достижения уровня липопротеинов низкой плотности <1,4 ммоль/л; противодиабетическая терапия с применением в том числе ингибиторов глюкозо-натриевого котранспортера 2-го типа и агонистов глюкагоноподобного пептида 1-го типа с достижением значения гликированного гемоглобина <7%; назначение антигипертензивной терапии и достижение целевых значений уровня артериального давления.

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The authors declare that there are no conflicts of interest present.