Transient ischaemic attack (TIA) – Related resources
26.02.2016 • Sonuncu dəyişiklik 26.09.2012
This article is created and updated by the EBMG Editorial Team
Cochrane reviews
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Antiplatelet drugs may prevent stroke after carotid endarterectomy .
Low intensity oral anticoagulation appears to be no more effective than antiplatelet therapy after transient ischaemic attack or minor stroke of presumed arterial origin in the prevention of further vascular events. High intensity anticoagulation significantly increases the risk of bleeding .
Ticlopidine and clopidogrel are slightly but significantly more effective than aspirin in preventing serious vascular events in high-risk individuals (and specifically in TIA/stroke patients). Clopidogrel and aspirin plus dipyridamole are as effective in reducing the risk of recurrent stroke. The risk of major haemorrhagic events, including intracranial haemorrhage, is lower with clopidogrel .
- Carotid endarterectomy for asymptomatic carotid stenosis reduces the risk of strokes by approximately 30% over three years but the absolute risk reduction is small and would be negated by a higher perioperative complication rate .
- In patients with symptomatic carotid stenosis who can undergo surgery safely, endovascular treatment is associated with an increased risk of peri-procedural stroke or death compared with endarterectomy, at least in patients over the age of 70 years .
- The risk of stroke and death is probably not different between local and general anaesthesia during carotid endarterectomy .
- Carotid patch angioplasty may reduce the risk of stroke or death compared to primary closure in patients undergoing carotid endarterectomy .
Extracranial-intracranial arterial bypass surgery in patients with symptomatic occlusive disease of carotid artery might possibly be equal to medical care alone, although the evidence is insufficient..
Other evidence summaries
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Restenosis rate after endarterectomy appears to be highest (about 10%) during the first year, and very small after the third year .
- Dipyridamole plus aspirin is at least as effective as aspirin alone for stroke prevention in people with previous stroke or TIA .
Literature
Clinical practice reviews
Brott TG, Hobson RW 2nd, Howard G, Roubin GS, Clark WM, Brooks W, Mackey A, Hill MD, Leimgruber PP, Sheffet AJ, Howard VJ, Moore WS, Voeks JH, Hopkins LN, Cutlip DE, Cohen DJ, Popma JJ, Ferguson RD, Cohen SN, Blackshear JL, Silver FL, Mohr JP, Lal BK, Meschia JF, CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 2010 Jul 1;363(1):11-23. POEM 120991