Stroke prevention: what's new?

Antithrombotic treatment has now been joined by other evidence-based drug interventions for pre-vention of stroke, including angiotensin-converting enzyme inhibitors and hydroxymethylglutaryl-CoA reductase inhibitors. The efficacy of oral anticoagulation in atrial fibrillation has not been seen in other stroke-prone groups, although trials are continuing. Diffusion-weighted magnetic resonance imaging improves diagnostic accuracy in acute stroke, which is important in arriving at the right secondary pre-vention strategy. Carotid endarterectomy has been shown to be beneficial for 50-69% symptomatic -stenosis but with a much narrower therapeutic index than for 70-99% stenosis. A comparison of endarter-ectomy with angioplasty and/or stent placement has been the subject of one small trial suggesting similar procedural stroke and mortality risks. Device closure of cardiac abnormalities increases in the absence of any trial data, and in spite of a low subsequent stroke risk for young patients with isolated patent foramen ovale treated with aspirin.