Stroke: Its Prevention, Its Treatment
Stroke, risk factors for degenerative vascular disease, and transient ischemic attacks (TIAs) continue to be major preoccupations of those in neurology. The majority of TIAs seem to be due to forward embolism from atheromatous plaques in the major vessels. Endarterectomy, anticoagulant agents, and platelet antiaggregating drugs (aspirin, sulfinpyrazone, dipyridamole) are the available modalities for treatment after cardiac and hematologic disorders have been eliminated as causes for circulatory insufficiency. Millikan and McDowell1 have provided an excellent review of the subject.When angiography demonstrates an atheromatous plaque at the carotid bifurcation, many investigators prefer surgical treatment. Still, however, the risks of both angiography and surgery must be weighed, and we have as yet no consensus on the long-term advantages of surgical operation over medical treatment.2,3 The frequency of TIAs can be reduced if anticoagulants such as heparin sodium and warfarin sodium are used early on,