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학술연구/단체지원/교육 등 연구자 활동을 지속하도록 DBpia가 지원하고 있어요.
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연구자들이 자신의 연구와 전문성을 널리 알리고, 새로운 협력의 기회를 만들 수 있는 네트워킹 공간이에요.
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For patients with symptomatic intracranial atherosclerosis (ICAS), antithrombotic agents are the mainstay of therapy. Anticoagulation (warfarin) is not widely used since it is not more effective than aspirin and carries a high risk of bleeding. New oral anticoagulants are showing promise, but their use has not been investigated in appropriate clinical trials. Since the recurrent stroke risk is high with aspirin monotherapy, dual antiplatelets are considered in the early stage of symptomatic ICAS. Based on the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) and Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) results, aspirin plus clopidogrel has been recommended. However, this combination was not superior to aspirin monotherapy in patients with ICAS in the CHANCE substudy. Progression of ICAS is common, and it is associated with recurrent strokes. In the Trial of Cilostazol in Symptomatic Intracranial Arterial Stenosis (TOSS) study, aspirin plus cilostazol was more effective than aspirin monotherapy in preventing progression. The TOSS II trial showed that the overall change in stenosis was better with aspirin plus cilostazol than with aspirin plus clopidogrel. Aside from antithrombotic therapy, risk factor management is critical for secondary prevention, and high blood pressure is clearly linked to recurrent stroke. However, blood pressure may have to be cautiously managed in the early stage of stroke. Considering that ICAS is the major cause of stroke worldwide, further investigations are needed to establish optimal management strategies for patients with ICAS.
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참고문헌 (63)
참고문헌 신청
Kwon SU / 2005 / Cilostazol prevents the progression of the symptomatic intracranial arterial stenosis: the multicenter double-blind placebo-controlled trial of cilostazol in symptomatic intracranial arterial stenosis / Stroke 36:782~786
Kwon SU / 2011 / Efficacy and safety of combination antiplatelet therapies in patients with symptomatic intracranial atherosclerotic stenosis / Stroke 42:2883~2890
Wong KS / 2002 / Progression of middle cerebral artery occlusive disease and its relationship with further vascular events after stroke / Stroke 33:532~536
Arenillas JF / 2001 / Progression and clinical recurrence of symptomatic middle cerebral artery stenosis: a long-term follow-up transcranial Doppler ultrasound study / Stroke 32:2898~2904
Schömig A / 2009 / Ticagrelor--is there need for a new player in the antiplatelet-therapy field? / N Engl J Med 361:1108~1111
Kwon SU / 2011 / Efficacy and safety of combination antiplatelet therapies in patients with symptomatic intracranial atherosclerotic stenosis / Stroke 42:2883~2890
Wong KS / 2002 / Progression of middle cerebral artery occlusive disease and its relationship with further vascular events after stroke / Stroke 33:532~536
Arenillas JF / 2001 / Progression and clinical recurrence of symptomatic middle cerebral artery stenosis: a long-term follow-up transcranial Doppler ultrasound study / Stroke 32:2898~2904
Schömig A / 2009 / Ticagrelor--is there need for a new player in the antiplatelet-therapy field? / N Engl J Med 361:1108~1111
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