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Nervenheilkunde 2020; 39(10): 644-650
DOI: 10.1055/a-1239-0344
Schwerpunkt
© Georg Thieme Verlag KG Stuttgart · New York

Sekundärprophylaxe der zerebralen Ischämie

Secondary prevention of cerebral infarction
Tilman Reiff
1   Neurologische Klinik, Universitätsklinikum Heidelberg
,
Peter A. Ringleb∗
1   Neurologische Klinik, Universitätsklinikum Heidelberg
› Author Affiliations
Further Information

Publication History

Publication Date:
09 October 2020 (online)

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ZUSAMMENFASSUNG

Die Sekundärprävention von Hirninfarkt und TIA umfasst neben wichtigen Maßnahmen der Lebensstiländerung zur Risikofaktorenmodifikation verschiedene medikamentöse und interventionelle Verfahren. Durch Behandlung von arterieller Hypertonie und Hyperlipidämie können erneute vaskuläre Ereignisse, Schlaganfall wie Herzinfarkt, verhindert werden. Eine große Bedeutung hat auch die antithrombotische Sekundärprävention durch Thrombozytenaggregationshemmer und orale Antikoagulantien sowie deren Kombination. Bei Vorliegen symptomatischer intra- oder extrakranieller arteriosklerotischer Stenosen können auch gefäßchirurgische oder neuroradiologisch interventionelle Verfahren der Verhinderung weiterer Schlaganfälle dienen.

ABSTRACT

Secondary prevention of cerebral infarction and TIA includes important lifestyle modification measures to modify risk factors as well as various drugs and interventions. Treating arterial hypertension, hyperlipidemia and diabetes can prevent recurrence of vascular events, as well as stroke as myocardial infarction. Antithrombotic secondary prevention using antiplatelets and oral anticoagulants, as well as their combination, is also of great importance. In the presence of symptomatic intra- or extracranial atherosclerotic stenoses, surgical or neuroradiological interventional procedures can also prevent further strokes.

Schlüsselwörter

Schlaganfall - Sekundärprävention - Risikofaktoren - Karotisstenose

Key words

Stroke - secondary prevention - risk factors - carotid stenosis
 

  • Literatur

  • 1 Turan TN, Nizam A, Lynn MJ. et al Relationship between risk factor control and vascular events in the SAMMPRIS trial. Neurology 2017; 88 (04) 379-85
    CrossrefPubMedGoogle Scholar
  • 2 Turnbull F. Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 2003; 362 9395 1527-35
    CrossrefPubMedGoogle Scholar
  • 3 Lawes CM, Bennett DA, Feigin VL. et al Blood pressure and stroke: an overview of published reviews. Stroke 2004; 35 (03) 776-85
    CrossrefPubMedGoogle Scholar
  • 4 Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009; 338: b1665
    Google Scholar
  • 5 Endres M, Diener H, Behnke M. et al Sekundärprophylaxe ischämischer Schlaganfall und transitorische ischämische Attacke; AWMF-Registernummer 030–133. www.awmf.org/leitlinien/detail/ll/030-133.html
    Google Scholar
  • 6 Trenkwalder P. Arterielle Hypertonie; Teil 2: Therapie. Internist (Berl) 2000; 41 2 Pt 1 W145-56
    CrossrefPubMedGoogle Scholar
  • 7 Amarenco P, Bogousslavsky J, Callahan A. et al High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med 2006; 355 (06) 549-59
    CrossrefPubMedGoogle Scholar
  • 8 Vergouwen MD, de Haan RJ, Vermeulen M. et al Statin treatment and the occurrence of hemorrhagic stroke in patients with a history of cerebrovascular disease. Stroke 2008; 39 (02) 497-502
    CrossrefPubMedGoogle Scholar
  • 9 Amarenco P, Kim JS, Labreuche J. et al A Comparison of Two LDL Cholesterol Targets after Ischemic Stroke. N Engl J Med 2020; 382 (01) 9
    CrossrefPubMedGoogle Scholar
  • 10 Kernan WN, Ovbiagele B, Black HR. et al Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45 (07) 2160-236
    CrossrefPubMedGoogle Scholar
  • 11 Bahrmann A, Bahrmann P, Baumann J. et al S2k-Leitlinie Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Alter. AWMF-Registernummer 057–017 https://www.awmf.org/leitlinien/detail/ll/057-017.html Stand: 12.03.2020
    Google Scholar
  • 12 Bellastella G, Maiorino MI, Longo M. et al Glucagon-Like Peptide-1 Receptor Agonists and Prevention of Stroke Systematic Review of Cardiovascular Outcome Trials With Meta-Analysis. Stroke 2020; 51 (02) 666-9
    CrossrefPubMedGoogle Scholar
  • 13 Guo M, Ding J, Li J. et al SGLT2 inhibitors and risk of stroke in patients with type 2 diabetes: A systematic review and meta-analysis. Diabetes Obes Metab 2018; 20 (08) 1977-82
    CrossrefPubMedGoogle Scholar
  • 14 Antithrombotic Trialists’ Collaboration Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324 7329 71-86
    CrossrefPubMedGoogle Scholar
  • 15 Johnson ES, Lanes SF, Wentworth CE. et al A metaregression analysis of the dose-response effect of aspirin on stroke. Arch Intern Med 1999; 159 (11) 1248-53
    CrossrefPubMedGoogle Scholar
  • 16 Rothwell PM, Cook NR, Gaziano JM. et al Effects of aspirin on risks of vascular events and cancer according to bodyweight and dose: analysis of individual patient data from randomised trials. Lancet 2018; 392 10145 387-99
    CrossrefPubMedGoogle Scholar
  • 17 Wang Y, Wang Y, Zhao X. et al Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med 2013; 369 (01) 11-9
    CrossrefPubMedGoogle Scholar
  • 18 Johnston SC, Rothwell PM, Nguyen-Huynh MN. et al Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet 2007; 369 9558 283-92
    CrossrefPubMedGoogle Scholar
  • 19 Johnston SC, Easton JD. et al Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA. N Engl J Med 2018; 379 (03) 215-25
    CrossrefPubMedGoogle Scholar
  • 20 Ibanez B, James S, Agewall S. et al 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Rev Esp Cardiol (Engl Ed) 2017; 70 (12) 1082
    Google Scholar
  • 21 Johnston SC, Amarenco P, Albers GW. et al Ticagrelor versus Aspirin in Acute Stroke or Transient Ischemic Attack. N Engl J Med 2016; 375: 35-43
    CrossrefPubMedGoogle Scholar
  • 22 Amarenco P, Albers GW, Denison H. et al Efficacy and safety of ticagrelor versus aspirin in acute stroke or transient ischaemic attack of atherosclerotic origin: a subgroup analysis of SOCRATES, a randomised, double-blind, controlled trial. Lancet neurology 2017; 16 (04) 301-10
    CrossrefPubMedGoogle Scholar
  • 23 Johnston SC, Amarenco P, Denison H. et al Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA. N Engl J Med 2020; 383 (03) 207-17
    CrossrefPubMedGoogle Scholar
  • 24 Grau AJ, Weimar C, Buggle F. et al Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank. Stroke 2001; 32 (11) 2559-66
    CrossrefPubMedGoogle Scholar
  • 25 EAFT Group Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 1993; 342: 1255-62
    CrossrefPubMedGoogle Scholar
  • 26 Connolly SJ, Ezekowitz MD, Yusuf S. et al Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361 (12) 1139-51
    CrossrefPubMedGoogle Scholar
  • 27 Granger CB, Alexander JH, McMurray JJ. et al Apixaban versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med 2011; 365 (11) 981-92
    CrossrefPubMedGoogle Scholar
  • 28 Patel MR, Mahaffey KW, Garg J. et al Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation. N Engl J Med 2011; 365 (10) 883-91
    CrossrefPubMedGoogle Scholar
  • 29 Giugliano RP, Ruff CT, Braunwald E. et al Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2013; 369 (22) 2093-104
    CrossrefPubMedGoogle Scholar
  • 30 Alberts MJ, Eikelboom JW, Hankey GJ. Antithrombotic therapy for stroke prevention in non-valvular atrial fibrillation. Lancet neurology 2012; 11 (12) 1066-81
    CrossrefPubMedGoogle Scholar
  • 31 Mohr JP, Thompson JL, Lazar RM. et al A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med 2001; 345 (20) 1444-51
    CrossrefPubMedGoogle Scholar
  • 32 Hart RG, Diener HC, Coutts SB. et al Embolic strokes of undetermined source: the case for a new clinical construct. Lancet neurology 2014; 13 (04) 429-38
    CrossrefPubMedGoogle Scholar
  • 33 Hart RG, Sharma M, Mundl H. et al Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source. N Engl J Med 2018; 378 (23) 2191-201
    CrossrefPubMedGoogle Scholar
  • 34 Diener HC, Sacco RL, Easton JD. et al Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source. N Engl J Med 2019; 380 (20) 1906-17
    CrossrefPubMedGoogle Scholar
  • 35 Häusler G, Gröschel K, Köhrmann M. et al Positionspapier zur Detektion von Vorhofflimmern nach ischämischem Schlaganfall. Aktuelle Neurologie 2017; 45: 93-106
    Google Scholar
  • 36 Gibson CM, Mehran R, Bode C. et al Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med 2016; 375 (25) 2423-34
    CrossrefPubMedGoogle Scholar
  • 37 Kirchhof P, Benussi S, Kotecha D. et al 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37 (38) 2893-962
    CrossrefPubMedGoogle Scholar
  • 38 Lopes RD, Heizer G, Aronson R. et al Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation. N Engl J Med 2019; 380 (16) 1509-24
    CrossrefPubMedGoogle Scholar
  • 39 Vranckx P, Valgimigli M, Eckardt L. et al Edoxaban-based versus vitamin K antagonist-based antithrombotic regimen after successful coronary stenting in patients with atrial fibrillation (ENTRUST-AF PCI): a randomised, open-label, phase 3b trial. Lancet 2019; 394: 1335-43
    CrossrefPubMedGoogle Scholar
  • 40 Lechat P, Mas JL, Lascault G. et al Prevalence of patent foramen ovale in patients with stroke. N Engl J Med 1988; 318 (18) 1148-52
    CrossrefPubMedGoogle Scholar
  • 41 Mas JL, Derumeaux G, Guillon B. et al Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke. N Engl J Med 2017; 377 (11) 1011-21
    CrossrefPubMedGoogle Scholar
  • 42 Sondergaard L, Kasner SE, Rhodes JF. et al Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke. N Engl J Med 2017; 377 (11) 1033-42
    CrossrefPubMedGoogle Scholar
  • 43 Saver JL, Carroll JD, Thaler DE. et al Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke. N Engl J Med 2017; 377 (11) 1022-32
    CrossrefPubMedGoogle Scholar
  • 44 Diener H, Grau A, Baldus S. et al Kryptogener Schlaganfall und offenes Foramen ovale, S2e-Leitlinie. In: DGfN (Hrsg.) Leitlinien für Diagnostik und Therapie in der Neurologie 2018
    Google Scholar
  • 45 Ntaios G, Papavasileiou V, Sagris D. et al Closure of Patent Foramen Ovale Versus Medical Therapy in Patients With Cryptogenic Stroke or Transient Ischemic Attack. Stroke 2018; 49 (02) 412-8
    CrossrefPubMedGoogle Scholar
  • 46 Rothwell PM, Eliasziw M, Gutnikov SA. et al Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 2003; 361 9352 107-16
    CrossrefPubMedGoogle Scholar
  • 47 Abbott AL, Paraskevas KI, Kakkos SK. et al Systematic Review of Guidelines for the Management of Asymptomatic and Symptomatic Carotid Stenosis. Stroke 2015; 46 (11) 3288-301
    CrossrefPubMedGoogle Scholar
  • 48 Eckstein H, Kühnl A, Berkefeld J. et al S3-Leitlinie zur Diagnostik, Therapie und Nachsorge der extracraniellen Carotisstenose; AWMF-Registernummer 004–028. www.awmf.org/leitlinien/detail/ll/004-028.html
    Google Scholar
  • 49 De Rango P, Brown MM, Didier L. et al Management of carotid stenosis in women: Consensus document. Neurology 2013; 80 (24) 2258-68
    CrossrefPubMedGoogle Scholar
  • 50 Rothwell PM, Gutnikov SA, Warlow CP. Reanalysis of the final results of the European Carotid Surgery Trial. Stroke 2003; 34 (02) 514-23
    CrossrefPubMedGoogle Scholar
  • 51 Bonati LH, Dobson J, Algra A. et al Short-term outcome after stenting versus endarterectomy for symptomatic carotid stenosis: a preplanned meta-analysis of individual patient data. Lancet 2010; 376 9746 1062-73
    CrossrefPubMedGoogle Scholar
  • 52 Howard G, Roubin GS, Jansen O. et al Association between age and risk of stroke or death from carotid endarterectomy and carotid stenting: a meta-analysis of pooled patient data from four randomised trials. Lancet 2016; 387 10025 1305-11
    CrossrefPubMedGoogle Scholar
  • 53 Brott TG, Calvet D. et al Long-term outcomes of stenting and endarterectomy for symptomatic carotid stenosis: a preplanned pooled analysis of individual patient data. Lancet neurology 2019; 18: 348-56
    CrossrefPubMedGoogle Scholar
  • 54 Kasner SE, Chimowitz MI, Lynn MJ. et al Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis. Circulation 2006; 113 (04) 555-63
    CrossrefPubMedGoogle Scholar
  • 55 Chimowitz MI, Lynn MJ, Derdeyn CP. et al Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 2011; 365 (11) 993-1003
    CrossrefPubMedGoogle Scholar
  • 56 Zaidat OO, Fitzsimmons BF, Woodward BK. et al Effect of a balloon-expandable intracranial stent vs medical therapy on risk of stroke in patients with symptomatic intracranial stenosis: the VISSIT randomized clinical trial. JAMA 2015; 313 (12) 1240-8
    CrossrefPubMedGoogle Scholar
  • 57 Compter A, van der Worp HB. et al Stenting versus medical treatment in patients with symptomatic vertebral artery stenosis: a randomised open-label phase 2 trial. Lancet neurology 2015; 14 (06) 606-14
    CrossrefPubMedGoogle Scholar
  • 58 Markus HS, Larsson SC, Kuker W. et al Stenting for symptomatic vertebral artery stenosis: The Vertebral Artery Ischaemia Stenting Trial. Neurology 2017; 89 (12) 1229-36
    CrossrefPubMedGoogle Scholar