Quoi de neuf dans la prévention secondaire de l’ischemie cérébrale ?

Abstract

Secondary prevention is a major goal after ischemic
stroke (IS) or TIA. Vascular risk factors have to be under
control especially arterial hypertension which is the major
“silent killer”. Antiplatelets have to be used in non cardio
embolic cause of IS or TIA and warfarin in cardiac causes.
Aspirin still remains the emergency antiplatelet. However,
Clopidogrel (Plavix®) and aspirine-dypiridamole
(Asasantine®) have been proven to have higher efficacy in
secondary prevention of cerebral ischemia. Recently the
PROFESS trial was published with direct comparison of
Plavix® versus Asasantine® with around the same level of
secondary protection for IS. There is no benefit to associate
aspirin and Clopidogrel for secondary prevention of IS.
Moreover, there is an increase risk of significant haemorrhage in such situation. Atorvastatin 80 mg has been proven effective and well tolerated in secondary prevention of
IS and TIA in the SPARCL trial. EVA3S and SPACE trials, with
direct comparison of carotid angioplasty and endarterectomy, failed to prove non inferiority of carotid angioplasty
which should be reserved for contra-indication of carotid
surgery.