Patient with non-cardioembolic ischemic stroke or high-risk transient ischemic attack. Part 2. Secondary prophylaxis
https://doi.org/10.14412/2074-2711-2023-3-4-10
Abstract
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.
About the Authors
A. A. KuleshRussian Federation
Alexey Alexandrovich Kulesh
26, Petropavlovskaya St., Perm 614990
Competing Interests:
none
S. N. Yanishevsky
Russian Federation
2, Akkuratova St., St. Petersburg 197341
Competing Interests:
none
D. A. Demin
Russian Federation
4, Pokrovskaya Roshcha St., Astrakhan 414011
Competing Interests:
none
L. I. Syromyatnikova
Russian Federation
26, Petropavlovskaya St., Perm 614990
Competing Interests:
none
O. I. Vinogradov
Russian Federation
70, Nizhnyaya Pervomayskaya St., Moscow 105203
Competing Interests:
none
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Review
For citations:
Kulesh AA, Yanishevsky SN, Demin DA, Syromyatnikova LI, Vinogradov OI. Patient with non-cardioembolic ischemic stroke or high-risk transient ischemic attack. Part 2. Secondary prophylaxis. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2023;15(3):4-10. (In Russ.) https://doi.org/10.14412/2074-2711-2023-3-4-10