Review of clinical guidelines for the treatment and prevention of ischemic stroke

Fedin A.I.; Badalyan K.R.

doi:https://doi.org/10.17116/jnevro201911908295

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Abstract:

One of the leading causes of death, disability and severe maladaptation of patients is ischemic stroke, which accounts for about 80% of all types of acute cerebrovascular accidents. At the same time, approximately 2/3 of the patients show residual effects of cerebral circulation disorders of varying severity. Currently, the problem of ischemic stroke attracts great attention and international and domestic recommendations developed for the prevention, treatment and rehabilitation of stroke patients are one of the aspects of work in this area. The article provides an overview of the latest clinical guidelines for the early management of patients with acute ischemic stroke of the American Heart Association and the American Stroke Association, as well as features of stroke therapy and prevention in Russia, Europe and USA.

Keywords:

ischemic stroke

clinical guidelines

therapy of ischemic stroke

Authors:

Fedin A.I.

Kafedra nevrologii Rossiĭskogo gosudarstvennogo meditsinskogo universiteta

SPIN RSCI: 8834-0085
Scopus AuthorID: 7007163263
ORCID: 0000-0002-6996-2828

Badalyan K.R.

Pirogov Russian National Research Medical University, Moscow

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References:

Gusev EI, Konovalov AN. Nevrologiya i neirokhirurgiya. Klinicheskie rekomendatsii. 2-e izd., pererab. i dop. M.: GEOTAR-Media; 2015. (In Russ.)
Gusev EI, Martynov MYu, Kamchatnov PR, Yasamanova AN, Shchukin IA, Kolesnikova TI. Cerebral stroke. Consilium Medicum. 2014;12:13-17. (In Russ.)
Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018;49(3):46-99. https://doi.org/10.1161/str.0000000000000163
Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C, Wang C, Li H, Meng X, Cui L, Jia J, Dong Q, Xu A, Zeng J, Li Y, Wang Z, Xia H, Johnston SC. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. New England Journal of Medicine. 2013;369:11-19. https://doi.org/10.1056/nejmoa1215340
Wang Y, Pan Y, Zhao X, Li H, Wang D, Johnston S., Liu L, Meng X, Wang A, Wang C, Wang Y. Clopidogrel With Aspirin in Acute Minor Stroke or Transient Ischemic Attack (CHANCE) trial: one-year outcomes. Circulation. 2015;132(1):40-46. https://doi.org/10.1161/circulationaha.114.014791
Johnston SC, Easton JD, Farrant M, Barsan W, Battenhouse H, Conwit R, Dillon C, Elm J, Lindblad A, Morgenstern L, Poisson SN, Palesch Y. Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial: rationale and design. International Journal of Stroke. 2013;8(6):479-483. https://doi.org/10.1111/ijs.12129
Saver JL, Starkman S, Eckstein M, Stratton SJ, Pratt FD, Hamilton S, Conwit R, Liebeskind DS, Sung G, Kramer I, Moreau G, Goldweber R, Sanossian N. Prehospital Use of Magnesium Sulfate as Neuroprotection in Acute Stroke. New England Journal of Medicine. 2015;372(6):528-536. https://doi.org/10.1056/nejmoa1408827
European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for Management of Ischaemic Stroke and Transient Ischaemic attack 2008. Cerebrovasc Dis. 2008;25(5):457-507. https://doi.org/10.1159/000131083
European Stroke Initiative: European stroke initiative recommendations for stroke management. European stroke council, european neurological society and european federation of neurological societies. Cerebrovascular Diseases. 2000;10(5):335-351. https://doi.org/10.1159/000016089
Shuaib A, Lees KR, Lyden P, Grotta J, Davalos A, Davis SM, Diener H-C, Ashwood T, Wasiewski WW, Emeribe U. Nxy-059 for the treatment of acute ischemic stroke. New England Journal of Medicine. 2007;357(6):562-571. https://doi.org/10.1056/nejmoa070240
Muir KW, Lees KR, Ford I, Davis S. Magnesium for acute stroke (intravenous magnesium efficacy in stroke trial): Randomised controlled trial. The Lancet. 2004;363(9407):439-445. https://doi.org/10.1016/s0140-6736(04)15490-1
Guzauskas GF, Boudreau DM, Villa KF, Levine SR, Veenstra DL. The cost-effectiveness of primary stroke centers for acute stroke care. Stroke. 2012;43(6):1617-1623. https://doi.org/10.1161/strokeaha.111.648238
Kruyt ND, Nederkoorn PJ, Dennis M, Leys D, Ringleb PA, Rudd AG, Vermeulen M, Stam J, Hacke W, Roos YB. Door-to-needle time and the proportion of patients receiving intravenous thrombolysis in acute ischemic stroke: uniform interpretation and reporting. Stroke. 2013;44(11):3249-3253. https://doi.org/10.1161/strokeaha.113.001885
Tul DzhF, Gusev EI, Gekht AB. Sosudistye zabolevaniya golovnogo mozga. Perevod s ang. pod redaktsiei, 6 izd. M.: GEOTAR-Media; 2007. (In Russ.).
Stakhovskaya LV, Kotov SV. Insul’t. Rukovodstvo dlya vrachei. M.: Izdatel’stvo MIA; 2018. (In Russ.)
Shamalov NA. Optimizachia reperfuzionnoy terapii u pacintov c ischemicheckim insultom: Dis... d-ra med. nauk. M. 2002. (In Russ.)
Klinicheskie rekomendatsii po provedeniyu tromboliticheskoi terapii pri ishemicheskom insul’te. M.; 2015. Accessed July 28, 2019. (In Russ.). https://mosgorzdrav.ru/ru-RU/science/default/download/472.html
Klinicheskie rekomendatsii po vedeniyu bol’nykh s ishemicheskim insul’tom i tranzitornymi ishemicheskimi atakami. M. 2015. Accessed July 28, 2019. (In Russ.). http://www.fesmu.ru/SITE/files/editor/file/fpk_pps/rv10.pdf.
Gusev EI, Konovalov AN, Skvortsova VI, Gekht AB. Nevrologiya. Natsional’noe rukovodstvo. M.: GEOTAR-Media; 2009. (In Russ.)
Gusev EI, Skvortsova VI. Ishemiya golovnogo mozga. M.: Meditsina; 2001. (In Russ.)
Skvortsova VI, Efremova NV, Shamalov NA. Cerebral ischemia and neuroprotection. The Quality of Life. Meditsina. 2006;2(13):35-42. (In Russ.)
Skvortsova VI, Stakhovskaya LV, Nartsyssov YuR, Bodykhov MK, Kuchuk IV, Gudkova YuV, Soldatenkova TD, Kondrasheva TT, Kalinina EV, Kerbikov OB. Randomized, double blind, placebo-controlled study of the efficacy and safety mexidol in complex therapy of ischemic stroke in the acute period. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova (Suppl «Insult»). 2006;18:48-54. (In Russ.)
Skvortsova VI, Stakhovskaya LV, Shamalov NA, Kerbikov OB. Results of a multicenter study of the safety and efficacy of cerebrolysin in patients with acute ischemic stroke. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova (Suppl «Insult»). 2006;16:41-45. (In Russ.)
Fedin AI, Rumyantseva SA, Piradov MA, Skoromets AA, Parfenov VA, Klocheva EG, Sholomov II, Kukhtsevich II, Zolkornyaev IG, Belonogov MA. The effectiveness of neurometabolic protector Cytoflavin in cerebral infarctions (multicenter randomized study). Vrach’. 2006;13:13-23. (In Russ.)
Chukanova EI, Gusev EI, Belousov DYu, Rep’ev AP, Belousov YuB. Results of a multicenter randomized controlled clinical and economic study of the treatment of the acute period of ischemic stroke with Cerebrolysin. Kachestvennaya Klinicheskaya Praktika. 2011;(3):14-37. (In Russ.)
Stakhovskaya LV, Meshkova KS, Dadasheva MN, Chefranova ZhYu, Titova LP, Lokshtanov TM, Zelenkina NYu, Alifirova VM, Pugachenko NV, Antukhova OM, Kovalenko AV, Doronin BM, Gordienko NYu, Shekhovtsova KV, Salimov KA, Shamalov NA. Results of multicenter randomize prospective double-blind placebo-controlled study of the safety and efficacy of cortexin in acute and subacute periods of hemispheric ischemic stroke. Vestnik Rossiiskoi Voenno-Meditsinskoi Akademii. 2012;37(1):238-244 (In Russ.)
Guekht A, Skoog I, Korczyn AD, Zakharov V, Eeg M, Vigonius U. A Randomised, Double-Blind, Placebo-Controlled Trial of Actovegin in Patients with Post-Stroke Cognitive Impairment: ARTEMIDA Study Design. Dementia and Geriatric Cognitive Disorders Extra. 2013;3(1):459-467. https://doi.org/10.1159/000357122
Aliferova VM, Dadasheva MN, Doronin BM, Kovalenko AV, Lokshtanova TM, Martynov MYu, Meshkova KS, Salimov KA, Stakhovskaya LV, Chefranova ZhYu, Shamalov NA. Clinical efficacy and pharmacoeconomic characteristics of the neuroprotection with low doses of cortexin in the treatment of acute ischemic stroke. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2014;114(4):41-46. (In Russ.)
Stakhovskaya LV, Shamalov NA, Khasanova DR, Mel’nikova EV, Agaf’ina AS, Golikov KV, Bogdanov EI, Yakupova AA, Roshkovskaya LV, Lukinykh LV, Lokshtanova TM, Poverennova IE, Shchepankevich LA. Results of a randomized double blind multicenter placebo-controlled, in parallel groups trial of the efficacy and safety of prolonged sequential therapy with mexidol in the acute and early recovery stages of hemispheric ischemic stroke (EPICA). Zhurnal Nevrologii i psikhiatrii im. S.S. Korsakova (Suppl «Insult»). 2017;117(3):55-65. (In Russ.) https://doi.org/10.17116/jnevro20171173255-65
Bel’skaya GN, Krylova TG. The effect of Cellex on the dynamics of speech disorders in the acute period of ischemic stroke. Pharmateka. 2015;13:1-4. (In Russ.)
Suslina ZA, Fedorova TN, Maksimova MYu. Antioxidant therapy for ischemic stroke. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2000;10:34-38. (In Russ.)
Lutskii MA, Akhmadeeva LR, Setchenkova NM, Magzhanov RV, Abdrashitova EV, Bulgakova AZ. An analysis of mexidol efficacy in the complex treatment of patients with ischemic stroke. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova (Spetsvypusk «Insul’t»). 2010;110(4):57-59. (In Russ.)
Odinak MM, Yanishevskii SN, Tsygan NV, Golokhvastov SYu, Voznyuk IA, Trufanov AG. The use of succinates for the correction of metabolic disorders in the penumbra in patients with stroke. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova («Spetsvypusk «Insul’t»). 2013;113(12):55-60. (In Russ.)
Izhbul’dina GI. Changes in the hemostasis system and free-radical lipid oxidation in the acute stage of ischemic stroke in patients on neuroprotection treatment. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova (Spetsvypusk «Insul’t»). 2012;112(3):31-37 (In Russ.)
Fedin AI, Evseev VN, Kuznetsov OR, Rumyantseva SA. Antioxidant therapy for ischemic stroke. Clinical and electrophysiological correlations. Russkii Meditsinskii Zhurnal. 2009;17(5):2-4 (In Russ.)
Zhang X, Liu X-T, Kang D-Y. Traditional Chinese Patent Medicine for Acute Ischemic Stroke. An Overview of Systematic Reviews Based on the GRADE Approach. Medicine (Baltimore). 2016;95(12):e2986. https://doi.org/10.1097/MD.0000000000002986
Chiao Y-W, Chen Y-J, Kuo Y-H, Lu C-Y. Traditional Chinese Medical Care and Incidence of Stroke in Elderly Patients Treated with Antidiabetic Medications. International Journal of Environmental Research and Public Health. 2018;15(6):1267. https://doi.org/10.3390/ijerph15061267
Torshin IYu, Gromova OA, Kobalava ZhD. About Errors in Meta-Analyses of Cardiovascular Effects of Omega-3 PUFA. Part 1. Pharmacological and Clinical Aspects of Validity in the Era of Post-Genomic Research, Artificial Intelligence and Big Data Analysis. Effektivnaya farmakoterapiya. Kardiologiya i Angiologiya. 2019;15(1):26-34. (In Russ.) https://doi.org/10.33978/2307-3586-2019-15-9-26-34