Stroke Subtypes and their Possible Implication in Stroke Prevention Drug Strategies
Antonino Tuttolomondo, Rosaria Pecoraro, Domenico Di Raimondo, Valentina Arnao, Giuseppe Clemente, Vittoriano Della Corte, Carlo Maida, Irene Simonetta, Giuseppe Licata and Antonio Pinto
Pages 824-837 (14)
Thrombotic strokes can affect large or small arteries in the brain. Drugs to prevent atherosclerosis complication
such as thrombotic strokes, should be drugs able to prevent the accumulation of intravascular fat, reduce vascular proliferation,
decrease blood pressure levels with the resulting shear stress, reduce platelet aggregation, and possibly partially or
totally reverse carotid plaques. Any of the commonly used antihypertensive drugs lower the incidence of stroke, with
larger reductions in BP resulting in larger reductions in risk. Experimental and clinical data suggest that reducing the activity
of the renin-angiotensin aldosterone system (RAAS) may have beneficial effects beyond the lowering of blood pressure
to reduce stroke incidence. In clinical trials, statins consistently reduced the risk of ischemic stroke in patients with or
without CHD whereas the data on the effects of other lipid modifying drugs on stroke risk are limited. Approximately
25% of strokes are recurrent. Antiplatelet therapy is indicated for the prevention of recurrent stroke in patients with a history
of noncardioembolic minor stroke or transient ischemic attack (TIA). Although clinicians may choose acetylsalicylic
acid (ASA) as first-line therapy for secondary prevention, clinical guidelines and evidence from trials suggest that ASA
may not be the most effective strategy. A recent review discussed results from clinical trials that have compared the efficacy
of ASA monotherapy versus ASA + extended release dipyridamole in secondary stroke prevention. Therefore it is
difficult to extrapolate the real benefit of pharmacological prevention strategies against atherothrombotic subtype for excellence
in the TOAST classification subtype that is represented by the LAAS and also with regard to lacunar subtype as
an expression of lipohyalinosis process which is a further aspect of atherosclerosis.
Atherosclerosis, atherotrombotic strokes, prevention, drugs.
Dipartimento Biomedico di Medicina Interna e Specialistica, Universita degli Studi di Palermo, Palermo, Italy.