Guidelines for Management of Ischaemic Stroke 2008 - ESO

ESO-Guidelines for Management of Ischaemic Stroke 2008
start oral anticoagulation. After TIA or minor stroke one could start immediately, but
after major stroke with significant infarction upon neuroimaging (e.g. above a third of
the MCA territory) one should wait for some (e.g. 4) weeks. However, this decision
has to be individualized.
In patients with AF and stable coronary disease, aspirin should not be added to oral
anticoagulation [331]. Anticoagulation may be beneficial in patients with aortic
atheroma [332], fusiform aneurysms of the basilar artery [333] or cervical dissection
[334]. The ongoing ARCH trial is comparing the combination of clopidogrel plus
aspirin with oral anticoagulation in secondary prevention of patients with
atherosclerotic plaques in the aortic arch.
Recurrent vascular event on antiplatelet therapy
The treatment of patients who have a recurrent vascular event on antiplatelet therapy
remains unclear. Alternative causes of stroke should be sought and consistent riskfactor
management is mandatory especially in those patients. Alternative treatment
strategies may be considered: leave unchanged, change to another antiplatelet
agent, add another antiplatelet agent, or use oral anticoagulation.
Surgery and angioplasty
Recommendations
CEA is recommended for patients with 70–99% stenosis (Class I, Level A). CEA
should only be performed in centres with a perioperative complication rate (all
strokes and death) of less than 6% (Class I, Level A)
It is recommended that CEA be performed as soon as possible after the last
ischaemic event, ideally within 2 weeks (Class II, Level B)
It is recommended that CEA may be indicated for certain patients with stenosis of
50–69%; males with very recent hemispheric symptoms are most likely to benefit
(Class III, Level C). CEA for stenosis of 50–69% should only be performed in
centres with a perioperative complication rate (all stroke and death) of less than
3% (Class I, Level A)
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