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Secondary Prevention After Ischemic Lacunar Stroke

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Ischemic Stroke Therapeutics

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Abstract

Cerebral small vessel disease (SVD) is a very frequent disease and has a crucial role in terms of acute (lacunar stroke) and chronic consequences (cognitive decline, psychiatric, gait, and urinary disorders, and functional loss). Stroke caused by SVD has rarely been the specific object of trials for secondary prevention of ischemic stroke, but a few data addressing this topic can be extracted from the literature. These data concern studies dealing with antihypertensive, antithrombotic, and lipid-lowering drugs, which enrolled a large amount of SVD patients. A few data are also available concerning anticoagulation and carotid surgery. More recently, one study (the SPS3 trial) specifically tackled secondary prevention strategies in patients with SVD stroke. The analysis of data coming from the above studies allow us to conclude that: (1) lowering of blood pressure after SVD stroke is desirable although the target remains to be further specified; (2) anti-aggregation (aspirin, cilostazol, and association of aspirin and dipyridamole) is efficacious but the association of aspirin and clopidogrel is associated with increased hemorrhagic risk without advantages; (3) statins may be used; (4) anticoagulant and carotid surgery are indicated only under specific circumstances.

Obviously, several more clinical trials specifically dealing with optimal treatment of SVD are needed.

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Authors and Affiliations

  1. NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy

    Raffaella Valenti M.D.

  2. NEUROFARBA Department, Neuroscience section, University of Florence, Stroke Unit and Neurology, Largo Brambilla 3, 50134, Florence, Italy

    Leonardo Pantoni M.D., Ph.D.

Authors
  1. Raffaella Valenti M.D.
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  2. Leonardo Pantoni M.D., Ph.D.
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Correspondence to Leonardo Pantoni M.D., Ph.D. .

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  1. Admiral Pihl Professor and Chairman of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA

    Bruce Ovbiagele

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Valenti, R., Pantoni, L. (2016). Secondary Prevention After Ischemic Lacunar Stroke. In: Ovbiagele, B. (eds) Ischemic Stroke Therapeutics. Springer, Cham. https://doi.org/10.1007/978-3-319-17750-2_13

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  • DOI: https://doi.org/10.1007/978-3-319-17750-2_13

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