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(Stroke. 2005;36:218.)
© 2005 American Heart Association, Inc.

Advances in Stroke 2004

Secondary Prevention of Recurrent Stroke

From the Consultant Neurologist and Head of Stroke Unit, Royal Perth Hospital, Clinical Professor, School of Medicine & Pharmacology, University of Western Australia.

Correspondence to Clinical Professor Graeme J. Hankey, Consultant Neurologist and Head of Stroke Unit, Department of Neurology, Royal Perth Hospital, 197 Wellington Street Perth, Australia 6001. E-mail gjhankey@cyllene.uwa.edu.au

Key Words: Advances in Stroke • endarterectomy • endarterectomy, carotid • stents • stroke prevention

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Recurrent stroke constitutes about one quarter of all strokes and arguably represents failed secondary prevention. In 2004, evidence emerged to refine the estimates of the early risk of recurrent stroke and optimize the secondary prevention of recurrent stroke by carotid revascularization, vascular risk factor control, and antiplatelet therapy.

Risk of Recurrent Stroke
The risk of stroke after a transient ischemic attack (TIA) or mild ischemic stroke was 10% within 1 week and 18% within the first 3 months in Oxfordshire, UK, in 2002 to 2003.¹ This substantial early risk is 3-fold higher if the TIA or ischemic stroke is caused by large artery disease and 5-fold lower if the cause is small artery disease.² The prevalence and level of other causal vascular risk factors also influence risk of recurrence.³

	Carotid Revascularization to Prevent Recurrent Stroke

 
Carotid Endarterectomy
Carotid endarterectomy reduces the risk of stroke in patients with recently symptomatic stenosis, and the benefit is greater in patients with greater degrees of stenosis (until the artery distal to the stenosis begins to collapse).⁴ An analysis of pooled data from 5893 patients randomized in the European Carotid Surgery Trial (ECST) and North American Symptomatic Carotid Endarterectomy Trial (NASCET) and followed up for 33 000 patient-years, revealed that the benefit from surgery was also greater in men, patients aged 75 years, and those randomized and operated upon within 2 weeks after their last ischemic event (and fell rapidly with increasing delay).⁵ Carotid endarterectomy should be targeted to these patients who are most likely to benefit.

Carotid Stent
Carotid artery stenting is less invasive than carotid endarterectomy but . . . [Full Text of this Article]

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