Clinical Guidelines for Acute Stroke Management - Living on the EDge

Section 7 Secondary Prevention
7.7 CAROTID SURGERY cont. GRADE LEVEL
g) Carotid angioplasty and stenting should not routinely be considered <strong>for</strong> patients B Level I 437 &
with symptomatic stenosis. However, it may be considered as an alternative in Level II
438, 439
certain circumstances, that is in patients who meet criteria <strong>for</strong> carotid
endarterectomy but are deemed unfit due to medical comorbidities
(e.g. significant heart/lung disease, age >80yrs), or conditions that make them
unfit <strong>for</strong> open surgery (e.g. high or low carotid bifurcation, carotid re-stenosis).
7.8 Patent <strong>for</strong>amen ovale
Patent <strong>for</strong>amen ovale (PFO) is more common in those
with cryptogenic stroke, especially those Simplification of drug dose regimens,
in<strong>for</strong>mation/education, motivation, counselling,
family therapy, support and reminders, and complex
or combined interventions were useful in promoting
adherence to prescription regimes. 446-448
> Education alone or in<strong>for</strong>ming people about adverse
drug effects did not change adherence. 448
> The use of multi-compartment packaging or other
reminder packing strategies to promote adherence
has conflicting evidence. One systematic review
found benefits of compliance among non-adherent
50