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      2014 Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack : Compiled by the Chinese Society of Neurology, Cerebrovascular Disease Group

      Author(s): 1 , 2 , 3
      Publication date Created:
      Publication date (Electronic):
      Journal: International Journal of Stroke
      Publisher: SAGE Publications

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          Abstract

          Ischemic stroke and transient ischemic attack (TIA) are the most common cerebrovascular disorder and leading cause of death in China. The Effective secondary prevention is the vital strategy for reducing stroke recurrence. The aim of this guideline is to provide the most updated evidence-based recommendation to clinical physicians from the prior version. Control of risk factors, intervention for vascular stenosis/occlusion, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke are all recommended, and the prevention of recurrent stroke in a variety of uncommon causes and subtype provided as well. We modified the level of evidence and recommendation according to part of results from domestic RCT in order to facility the clinical practice.

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          Most cited references108

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          2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults

          Neil J Stone, Jennifer G Robinson, Alice H. Lichtenstein … (2014)
          Supplemental Digital Content is available in the text.
          Article 0 comments Cited 1007 times – based on 0 reviews     Review now
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            Stenting versus aggressive medical therapy for intracranial arterial stenosis.

            Marc I Chimowitz, Michael J Lynn, Colin Derdeyn … (2011)
            Atherosclerotic intracranial arterial stenosis is an important cause of stroke that is increasingly being treated with percutaneous transluminal angioplasty and stenting (PTAS) to prevent recurrent stroke. However, PTAS has not been compared with medical management in a randomized trial. We randomly assigned patients who had a recent transient ischemic attack or stroke attributed to stenosis of 70 to 99% of the diameter of a major intracranial artery to aggressive medical management alone or aggressive medical management plus PTAS with the use of the Wingspan stent system. The primary end point was stroke or death within 30 days after enrollment or after a revascularization procedure for the qualifying lesion during the follow-up period or stroke in the territory of the qualifying artery beyond 30 days. Enrollment was stopped after 451 patients underwent randomization, because the 30-day rate of stroke or death was 14.7% in the PTAS group (nonfatal stroke, 12.5%; fatal stroke, 2.2%) and 5.8% in the medical-management group (nonfatal stroke, 5.3%; non-stroke-related death, 0.4%) (P=0.002). Beyond 30 days, stroke in the same territory occurred in 13 patients in each group. Currently, the mean duration of follow-up, which is ongoing, is 11.9 months. The probability of the occurrence of a primary end-point event over time differed significantly between the two treatment groups (P=0.009), with 1-year rates of the primary end point of 20.0% in the PTAS group and 12.2% in the medical-management group. In patients with intracranial arterial stenosis, aggressive medical management was superior to PTAS with the use of the Wingspan stent system, both because the risk of early stroke after PTAS was high and because the risk of stroke with aggressive medical therapy alone was lower than expected. (Funded by the National Institute of Neurological Disorders and Stroke and others; SAMMPRIS ClinicalTrials.gov number, NCT00576693.).
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              Homocysteine lowering with folic acid and B vitamins in vascular disease.

              Eva Lonn, Salim Yusuf, Malcolm Arnold … (2006)
              In observational studies, lower homocysteine levels are associated with lower rates of coronary heart disease and stroke. Folic acid and vitamins B6 and B12 lower homocysteine levels. We assessed whether supplementation reduced the risk of major cardiovascular events in patients with vascular disease. We randomly assigned 5522 patients 55 years of age or older who had vascular disease or diabetes to daily treatment either with the combination of 2.5 mg of folic acid, 50 mg of vitamin B6, and 1 mg of vitamin B12 or with placebo for an average of five years. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, and stroke. Mean plasma homocysteine levels decreased by 2.4 micromol per liter (0.3 mg per liter) in the active-treatment group and increased by 0.8 micromol per liter (0.1 mg per liter) in the placebo group. Primary outcome events occurred in 519 patients (18.8 percent) assigned to active therapy and 547 (19.8 percent) assigned to placebo (relative risk, 0.95; 95 percent confidence interval, 0.84 to 1.07; P=0.41). As compared with placebo, active treatment did not significantly decrease the risk of death from cardiovascular causes (relative risk, 0.96; 95 percent confidence interval, 0.81 to 1.13), myocardial infarction (relative risk, 0.98; 95 percent confidence interval, 0.85 to 1.14), or any of the secondary outcomes. Fewer patients assigned to active treatment than to placebo had a stroke (relative risk, 0.75; 95 percent confidence interval, 0.59 to 0.97). More patients in the active-treatment group were hospitalized for unstable angina (relative risk, 1.24; 95 percent confidence interval, 1.04 to 1.49). Supplements combining folic acid and vitamins B6 and B12 did not reduce the risk of major cardiovascular events in patients with vascular disease. (ClinicalTrials.gov number, NCT00106886; Current Controlled Trials number, ISRCTN14017017.). Copyright 2006 Massachusetts Medical Society.
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                Author and article information

                Journal
                Title: International Journal of Stroke
                Abbreviated Title: International Journal of Stroke
                Publisher: SAGE Publications
                ISSN (Print): 1747-4930
                ISSN (Electronic): 1747-4949
                Publication date Created: October 24 2016
                Publication date Created: April 2017
                Publication date (Electronic): March 06 2017
                Publication date (Print): April 2017
                Volume: 12
                Issue: 3
                Pages: 302-320
                Affiliations
                [1 ]Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
                [2 ]Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
                [3 ]Department of Neurology, The General Hospital of Chinese People’s Liberation Army, Beijing, China
                Article
                DOI: 10.1177/1747493017694391
                PubMed ID: 28381199
                SO-VID: 6fe6270e-d963-46ff-8887-6f10187ca5de
                Copyright © © 2017
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                http://journals.sagepub.com/page/policies/text-and-data-mining-license

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