Secondary prevention of ischemic stroke

Stroke, commonly known as stroke, can be divided into ischemic stroke and hemorrhagic stroke, and stroke is the second leading cause of death worldwide and the number one cause of acquired long-term disability [1].

The risk factors for ischemic stroke are divided into preventable factors and unpreventable factors, and the preventable factors are mainly hypertension, hyperlipidemia, diabetes, sleep apnea, hyperhomocysteinemia, heart disease (atrial fibrillation, valvular heart disease, acute myocardial infarction, foramen ovale, etc.

First, control risk factors

1.

A few days after the onset of ischemic stroke, the patient is stable and should initiate antihypertensive therapy
if the systolic blood pressure is higher than 140 mmHg and the diastolic blood pressure is higher than 90 mmHg.

2.

First of all, blood lipids should be controlled through appropriate exercise and a healthy lifestyle; After improving lifestyle, those who still have poor lipid control need to use drug intervention
.

3.

Controlled glycosylated hemoglobin (HbA1c) to less than 7.

4.

Hyperhomocysteinemia is also a risk factor for ischemic stroke, and for recent ischemic strokes, folic acid can be given to reduce homocysteine, but there is still insufficient evidence-based medical evidence
to reduce the recurrence of ischemic stroke.

5.

If conditions permit, the patient should be given a sleep respiration test; In patients with sleep apnea, continuous positive pressure ventilation is preferred to improve patient outcomes
.

6.

Risk factors such as smoking, alcohol consumption, physical inactivity, and psychosocial factors can also increase the incidence of stroke; A healthy lifestyle such as smoking cessation, alcohol cessation, proper exercise, and emotional regulation are also essential
for secondary prevention of ischemic stroke.

Second, the application of oral antithrombotic drugs in the secondary prevention of non-cardiac ischemic stroke or transient ischemic attack (TIA).

Currently well-documented antithrombotic agents are a combination of aspirin, clopidogrel, aspirin and dipyridamo
.

Third, the effectiveness and safety of traditional Chinese medicine in the secondary prevention of ischemic stroke

Traditional Chinese medicine also plays an important role
in the secondary prevention of ischemic stroke.
For people who are developing cardiovascular and cerebrovascular diseases, the key to treatment is to unblock blood vessels and stabilize plaque.

The world's first clinical evidence-based study of traditional Chinese medicine intervention in carotid artery plaques, "randomized, double-blind, placebo-controlled, multi-center clinical study of carotid artery plaque intervention by using macaroni network", found that macaroni capsules can safely and effectively reduce the thickness of the middle membrane, plaque area and vascular reconstruction index of carotid artery, indicating that macaroni capsules can stabilize and inhibit vulnerable plaques in blood vessels [7].

。 In addition, studies such as Fuwai Hospital of the Chinese Academy of Medical Sciences have shown that macaroni capsules can protect the endothelial structure of the heart microvascular vessels, significantly reduce the area without reflux after reperfusion, and promote microangiogenesis, truly achieve reperfusion, and promote the rapid recovery of cardiac function [8].

Other studies have shown that macaroni capsules can significantly promote angiogenesis in ischemic areas, establishing new blood pathways for them and restoring blood supply to ischemic areas [9-12].

The West China Hospital of Sichuan University and 11 hospitals have confirmed that the macaroni network treatment group can significantly reduce the recurrence rate of cardiovascular and cerebrovascular events in patients with cerebral infarction, improve the motor function and cognitive function of patients, and improve the quality of life of stroke patients [13].

It has also been confirmed that macaroni capsules can effectively improve the disorder of lipid metabolism in patients in the secondary prevention of ischemic stroke, inhibit hypercoagulable blood states, inhibit thrombosis and inhibit the further enlargement of thrombosis that has been formed, and can effectively reduce the recurrence rate of stroke [14].

At present, the research related to the secondary prevention of stroke in traditional Chinese medicine is still in development, and it is expected that more high-quality related research will provide more choices
for the secondary prevention of ischemic stroke patients.

4.
Anticoagulation therapy for cardiogenic stroke

For ischemic stroke due to atrial fibrillation, oral anticoagulants such as warfarin and rivaroxaban are usually given within 2 weeks after the occurrence of ischemic stroke events, and patients at risk of bleeding should postpone anticoagulation
.
If anticoagulation is not available, aspirin monotherapy or aspirin plus clopidogrel antiplatelet aggregation
may be given.

5.
Interventional treatment of intracranial and extracranial vascular stenosis

Patients with ischemic stroke with symptomatic intracranial and pericranial atherosclerotic severe stenosis (stenosis >70%) may be treated with active medical treatment
accompanied by adequate evaluation.
Such as intracranial artery vascular stenting, carotid endarterectomy, and percutaneous carotid stent angioplasty
.
Treatment options should be individualized and carefully chosen
.

Ischemic stroke has the characteristics of high incidence, high disability rate, high mortality, high recurrence rate, high economic burden, etc.
, which seriously affects the quality of life of patients and causes a heavy burden on families and society; Individualized, holistic, ultra-early secondary prevention significantly reduces recurrence
of ischemic stroke.
At the same time, health education for patients and their families to improve their awareness of the disease is also conducive to improving patients' compliance with secondary prevention, thereby better improving the quality of life of
patients.