The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale.

Guidelines for the Primary Prevention of Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

IDEALLY, treatment of a patient with cerebral ischemia should be guided by knowledge of the nature, location, and severity of the occlusive disease within the extracranial and intracranial vessels.' To plan efficient evaluation of the individual patient, the responsible clinician must be familiar with the relative probability of finding occlusive lesions at various sites within the vascular tree since individual imaging and non-invasive tests have different capabilities with regard to various vascular loci. A growing body of data suggests that there are important differences in the distribution of occlusive vascular disease in Blacks and Whites and in men and women. This review summarizes the presently available data.

Race, sex and occlusive cerebrovascular disease: a review.

We review the eight prospective and seven retrospective studies from which it is possible to derive the complication rate of conventional cerebral angiography for patients with mild ischemic cerebrovascular disease who are potential candidates for carotid endarterectomy. Three studies of intravenous and one of intra-arterial digital subtraction angiography are also examined. An overview of the results suggests that the risk of a neurological complication (TIA or stroke) is about 4% and that a permanent neurological deficit (disabling stroke) occurs in about 1%. The mortality rate is very low (less than 0.1%). Systemic complications are not infrequent, particularly with intravenous digital subtraction angiography. The complication rate of cerebral angiography must be considered when evaluating the risks of carotid endarterectomy in patients with ischemic cerebrovascular disease.

https://www.ahajournals.org/doi/pdf/10.1161/01.STR.21.2.209

Cerebral angiographic risk in mild cerebrovascular disease.

A series of 316 patients with transient cerebral ischemic attacks and no neurological deficit were randomly allocated to surgical or nonsurgical treatment categories in a controlled manner. The total group was divided by anatomical patterns of lesions (carotid stenosis, unilaterally; carotid stenosis, bilaterally; and unilateral occlusion with opposite stenosis). During an average 42-month follow-up, distinct differences in outcome were noted in specific subgroups in the frequency and pattern of transient attacks and in the occurrence and location of cerebral infarction.

Joint study of extracranial arterial occlusion. V. Progress report of prognosis following surgery or nonsurgical treatment for transient cerebral ischemic attacks and cervical carotid artery lesions.

Ultrasonographic measurement of the common carotid artery wall thickness in hypercholesterolemic patients A new model for the quantitation and follow-up of preclinical atherosclerosis in living human subjects

For 80% of 4,748 patients with cerebrovascular insufficiency, complete four-vessel examinations were made. Although the primary purpose was localization of surgically accessible extracranial lesions, intracranial studies were also obtained in a high percentage of cases. The overall grave complication rate was 1.2%. A test of interinstitutional comparability of x-ray interpretation revealed greatest agreement when lesions compromised more than 50% of the arterial lumen.

https://jamanetwork.com/journals/JAMA/articlepdf/338339/jama_203_11_011.pdf

Raymond B. Bauer

Papers

Joint Study of Extracranial Arterial Occlusion II. Arteriography, Techniques, Sites, and Complications