[Medical treatment of intracranial arterial stenosis. Are primary and secondary prevention the same thing?].
OBJECTIVE
In this study we review the risk factors associated with the formation and progression of an atheroma plaque, the mechanism involved in cerebral ischemia secondary to intracranial atheromatosis and possible medical treatment in primary and secondary prevention.


METHODS
Medical treatment of intracranial stenoses (ICS) is aimed at stopping the progression of the atheroma plaque and at preventing recurrences in the case of symptomatic stenoses. It is based on the control of vascular risk factors, the use of statins and antithrombotic therapy (antiplatelet or anticoagulation drugs). Although antiplatelet agents have not proved to be beneficial in the primary prevention of stroke, they are recommended in patients with ICS in order to lower the risk of heart attack associated with this pathology. The use of antiplatelet drugs in the secondary prevention of ischemic stroke secondary to an ICS is based on clinical trials which have shown that antiaggregation prevents non-cardioembolic strokes. Nevertheless, several retrospective studies have observed that oral anticoagulation is better than antiaggregation with aspirin. Two prospective clinical trials are currently being conducted which will, in the next few years, help to determine what the first choice medical treatment is for this group of patients.


CONCLUSIONS
Medical treatment of ICS patients must include the control of vascular risk factors and the use of statins. New studies are needed to be able to establish the first choice antithrombotic drug in secondary prevention.
Departamento de Neurología, Clinica Universitaria de Navarra, Pamplona, España. pirimia@unav.es
P
P
Irimia-Sieira
M
M
Riverol-Fernández
E
E
Martínez-Vila
D001161:Arteriosclerosis / Q000150:complications* / Q000188:drug therapy / Q000473:pathology*; D002545:Brain Ischemia / Q000188:drug therapy / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D002561:Cerebrovascular Disorders / Q000188:drug therapy / Q000473:pathology / Q000517:prevention & control; D002986:Clinical Trials as Topic; D003251:Constriction, Pathologic / Q000188:drug therapy / Q000473:pathology / Q000517:prevention & control; D018450:Disease Progression; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012307:Risk Factors
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors