Small Vessel Disease

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
Blood Pressure ◽  
Antiplatelet Therapy ◽  
Stroke Prevention ◽  
Small Vessel Disease ◽  
Secondary Stroke Prevention ◽  
Lacunar Stroke ◽  
Pressure Management ◽  
Vessel Disease ◽  
Blood Pressure Management

Lacunar strokes are strongly associated with hypertension. Long-term blood pressure management is important after lacunar stroke. Antiplatelet therapy should be instituted for secondary stroke prevention.

Antiplatelet Therapy in Noncardioembolic Stroke: A Review of Current Evidence

2017 ◽  
Vol 37 (03) ◽  
pp. 366-375
Author(s):  
Per Sandset ◽  
Else Sandset ◽  
Kailash Krishnan ◽  
Mirza Jusufovic
Keyword(s):  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Small Vessel Disease ◽  
Current Evidence ◽  
Stroke Recurrence ◽  
First Year ◽  
Vessel Disease ◽  
Risk Of Bleeding ◽  
Developed World

AbstractAcute stroke is a leading cause of death and disability in the developed world. Among survivors, the risk of stroke recurrence is highest within the first few days, and up to 15% will be affected within the first year. In the case of noncardioembolism, antiplatelets, such as aspirin, clopidogrel, and the combination of aspirin and dipyridamole, remain the mainstay of treatment. Aspirin given immediately is beneficial, but when combined with clopidogrel is associated with a higher risk of bleeding. Dual antiplatelet therapy of aspirin and dipyridamole was no more effective than clopidogrel in reducing stroke recurrence. In symptomatic extracranial atherosclerosis, surgery within 2 weeks of the index event will benefit, but in strokes due to intracranial atherosclerosis and small vessel disease, medical therapy alone is recommended. The purpose of this review is to discuss the various trials of antiplatelet therapies in acute and long-term stroke prevention in mechanisms excluding cardioembolism.

Abstract TP375: Using Characteristics of Secondary Ischemic Stroke Events to Improve Stroke Education Initiatives

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Amanda Dirickson ◽  
Suzanne Stone
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Stroke Prevention ◽  
Small Vessel Disease ◽  
Secondary Stroke Prevention ◽  
Stroke Treatment ◽  
Vessel Disease ◽  
Acute Stroke Treatment ◽  
Stroke Education ◽  
Toast Classification

Purpose: While it is common practice for nursing to perform the duty of stroke education,it is not common to use secondary stroke event data to determine what aspect of stroke education should be emphasized for the greatest impact on secondary stroke prevention. The purpose of this descriptive study is to exam the characteristics of secondary stroke events using the TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria so future educational initiatives can be customized to the needs of the local high risk population. Methods: The team collected data characteristics on all ischemic stroke admissions with previous admitting diagnosis of acute ischemic stroke. The strokes were further characterized using the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification to determine any emerging patterns of both risk factors and etiological types. Conclusions: A total of n=51 admissions were previous adult stroke survivors, (M=30, F=21). Pre-morbid risk factors were as follows: hypertension=78%, type 2 diabetes=39%, hyperlipidemia =54%, smoking=8%, atrial fibrillation=24%. TOAST classification results: Large Vessel Atherosclerosis=14%, Cardioembolic =17%, Small Vessel Disease=3%, Other Known Cause=2%, Cryptogenic=15%. Summary: The results reveal a striking pattern of the presence of premorbid hypertension. While the TOAST classification did not have a single dominant type, but nearly equal distribution of large vessel atherosclerosis, cardioembolic, and small vessel disease etiologies. Not surprising, the decline in stroke mortality is felt to be due to improved blood pressure control, but in discharge stroke education, hypertension is not necessarily emphasized over other perhaps less impactful risk factors. Yet, the most recent acute ischemic stroke clinical guidelines gave providers a first-time recommendation to start or restart antihypertensive therapy in stable patients with BP > 140/90. Nursing has enough encouragement to take the lead on hypertension prevention education in appropriate stable patients ready for discharge. The next goal will be to develop a multimedia educational effort in patient stroke education on hypertension as a risk factor for secondary stroke prevention in this Comprehensive Stroke Center.

scholarly journals Preventing cognitive decline and dementia from cerebral small vessel disease: The LACI-1 Trial. Protocol and statistical analysis plan of a phase IIa dose escalation trial testing tolerability, safety and effect on intermediary endpoints of isosorbide mononitrate and cilostazol, separately and in combination

2017 ◽  
Vol 13 (5) ◽  
pp. 530-538 ◽  
Author(s):  
Gordon W Blair ◽  
Jason P Appleton ◽  
Zhe Kang Law ◽  
Fergus Doubal ◽  
Katie Flaherty ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Platelet Function ◽  
Dose Escalation ◽  
Small Vessel Disease ◽  
Cerebrovascular Reactivity ◽  
Phase Iii ◽  
Small Vessel ◽  
Isosorbide Mononitrate ◽  
Lacunar Stroke ◽  
Vessel Disease

Rationale The pathophysiology of most lacunar stroke, a form of small vessel disease, is thought to differ from large artery atherothrombo- or cardio-embolic stroke. Licensed drugs, isosorbide mononitrate and cilostazol, have promising mechanisms of action to support their testing to prevent stroke recurrence, cognitive impairment, or radiological progression after lacunar stroke. Aim LACI-1 will assess the tolerability, safety, and efficacy, by dose, of isosorbide mononitrate and cilostazol, alone and in combination, in patients with ischemic lacunar stroke. Sample size A sample of 60 provides 80+% power (significance 0.05) to detect a difference of 35% (90% versus 55%) between those reaching target dose on one versus both drugs. Methods and design LACI-1 is a phase IIa partial factorial, dose-escalation, prospective, randomized, open label, blinded endpoint trial. Participants are randomized to isosorbide mononitrate and/or cilostazol for 11 weeks with dose escalation to target as tolerated in two centers (Edinburgh, Nottingham). At three visits, tolerability, safety, blood pressure, pulse wave velocity, and platelet function are assessed, plus magnetic resonance imaging to assess cerebrovascular reactivity in a subgroup. Study outcomes Primary: proportion of patients completing study achieving target maximum dose. Secondary symptoms whilst taking medications; safety (hemorrhage, recurrent vascular events, falls); blood pressure, platelet function, arterial stiffness, and cerebrovascular reactivity. Discussion This study will inform the design of a larger phase III trial of isosorbide mononitrate and cilostazol in lacunar stroke, whilst providing data on the drugs’ effects on vascular and platelet function. Trial registration ISRCTN (ISRCTN12580546) and EudraCT (2015-001953-33).

Long‐term survival and cognitive function according to blood pressure management during cardiac surgery. A follow‐up

2020 ◽  
Vol 64 (7) ◽  
pp. 936-944 ◽  
Author(s):  
Mo H. Larsen ◽  
Christina Draegert ◽  
Anne G. Vedel ◽  
Frederik Holmgaard ◽  
Volkert Siersma ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiac Surgery ◽  
Cognitive Function ◽  
Pressure Management ◽  
Term Survival ◽  
Long Term Survival ◽  
Blood Pressure Management
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