Secondary prevention in cerebral ischemia: Efficacy of aspirin and surgery

In patients with a TIA or non-disabling ischaemic stroke, the annual risk of death from all vascular causes, nonfatal stroke, or nonfatal myocardial infarction is 7-12%. Two main approaches of secondary prevention are available, one medical, the other surgical, With aspirin in any dose between 30 and 1,300 mg/day, the rate of reduction of vascular outcome events is 15%; this leaves much room for improvement. Lower doses, however, cause fewer side effects. The efficacy of ticlopidine is of the same magnitude as that of aspirin. That of other drugs is unproven. Carotid endarterectomy is indicated in patients with cortical symptoms or signs and severe carotid stenosis (70-99% diameter reduction) and it is contraindicated in patients with mild stenosis (0-29%).