KARG E R. Stroke Prevention. Editors Wolfgang Domdorf, Giessen Peter Marx, Berlin. 26 figures and 29 tables, 1994
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1 Stroke Prevention
2
3 Stroke Prevention Editors Wolfgang Domdorf, Giessen Peter Marx, Berlin 26 figures and 29 tables, 1994 KARG E R Basel Freiburg Paris. London. New York New Delhi. Bangkok Singapore. Tokyo Sydney
4 Library of Congress Cataloging-in-Publication Data International Symposium on Stroke Prevention (1992 Berlin, Germany) Stroke prevention / International Symposium on Stroke Prevention, Berlin, April 12-14, 1992 ; editors: Wolfgang Dorndorf, Peter Marx. Includes bibliographical references and index. ISBN (alk. paper) 1. Cerebrovascular disease-prevention-congresses. I. Dorndorf, Wolfgang. II. Marx, Peter, III. Title. [DNLM: 1. Cerebrovascular Disorders-prevention & control-congresses. 2. Cerebrovascular Disorders-etiology-congresses. 3. Risk Factors-congresses. WL 355 I6045s 1992] RC388.5.I '1-dc20 DNLM/DLC for Library of Congress CIP Drug Dosage The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, núcrocopying, or by any information storage and retrieval system, without permission in writtíng from the publisher. Copyright 1994 by S. Karger GmbH, Postfach, D Freiburg, and S. Karger AG, P. 0. Box, CH-4009 Basel Printed in Germany by Konkordia Druck GmbH, D Bühl ISBN
5 Contents Preface VII Classification Mohr, J. P. (New York, N. Y.): Classification of Strokes: Experience from Stroke Data Banks 1 Ringelstein, E. B. (Munster); Weiller, C. (Essen): Etiological Classification of Ischemíc Strokes: Evidence from CT and SPECT Imaging 14 Mast, H.; Nussel, F.; Vogel, H. P.; Heinsius, T.; Dissmann, R.; Völler, H.; Marx, P (Berlin): Cranial Computerized Tomography Stroke Patterns in Patients with Cardiac Sources of Embolism, Extracranial Macroangiopathy or No Extracranial Sources 28 Risk Factors Diener, H. C. (Essen): Predictive Value of Major Risk Factors and the Impact of Their Control 37 Kessler, C. M. (Lubeck); Kelly, A. B.; Suggs, W. D.; Hanson, S. R.; Harker, L. A (Atlanta, Ga.): Transient Ischemíc Attacks in Baboons due to Platelet Microembolí 45 Haass, A. (Homburg/Saar): Hemorheologícal Risk Factors for Ischemíc Stroke 53 Marx, P.; Mast, H.; Schumacher, Ch.; Ossmann, R.; Völler, H. (Berlin): Do Risk Factors Relate to Stroke Pattern? Evidence from the Berlin Stroke Data Bank 67 Secondary Prevention in Vascular Disease Hennerici, M. G. (Mannheim): Secondary Prevention in Vascular Disease: Assessment of the Risk of Stroke Recurrence 76 Lowenthal, A. (Antwerp); Smets, P. (Brussels): Can We Compare the Four Main Studies of Secondary Prevention of Ischemíc Lesions of the Nervous System (European Stroke Prevention Study, United Kingdom-TIA Study, Canadian-American Ticlopidine Study and Swedish Aspirin Low-Dose Trial)? 82
6 Contents VI Pryse-Phillips, W. (St. John's, Nfld.): Ticlopidine in the Prevention of Stroke 91 Rudofsky, G. (Essen): Ultrasound in Recognition, Epidemiology and Prevention of Atherosclerosis. A Preliminary Communication 103 Betz, E. (Tübingen): Drug Inhibition of Atherogenesis: New Approaches 113 Surgical and Interventional Prevention Gijn, J. van (Utrecht): Surgical Complications of Carotid Endarterectomy 122 Busse, O. (Minden): Current State of Carotid Endarterectomy 131 Brown, M. M. (London): Balloon Angioplasty 144 Cardioembolic Stroke Kaps, M. (Giessen): Detection of Embolic Events by Ultrasound 153 Hornig, C. R. (Giessen): Risk Evaluation of Anticoagulant Therapy in Cardioembolic Stroke 165 Koudstaal, P. J. (Rotterdam): Nonvalvular Atrial Fibrillation and Stroke 180 Boysen, G.; Petersen, P.; Godtfredsen, J. (Copenhagen): Prevention of Cardioembolic Stroke 188 Subject Index 197
7 Preface Despite growing knowledge about the pathophysiology of cerebral ischemia and great efforts to find rational therapies, stroke treatment is still not very effective, leaving many survivors chronically disabled. In contrast to the scanty results of stroke treatment, stroke prevention is quite efficacious in hypertensive patients and those with atrial fibrillation and severe symptomatic carotid stenosis. Based on knowledge about risk factors and improved methods to identify stroke etiologies in individual patients, various interventional studies have been initiated and proved that stroke can be avoided in a considerable number of patients. In order to give a summary of state of the art science in this field and also to discuss future developments, an International Symposium on Stroke Prevention was held in Berlin in April Leading scientists from Europe and abroad discussed issues such as Etiological Classification of Stroke, Risk Factor Evaluation, Secondary Prevention in Vascular Disease, Surgical and Interventional Prevention, and Prevention of Cardioembolic Stroke. The results of this meeting are presented in this book. The editors are indebted to all participants who contributed to this publication. Wolfgang Dorndorf Peter Marx
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