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Evidence-based review of primary and secondary ischemic stroke prevention in adults: A neurosurgical perspective

机译：成人原发性和继发性缺血性卒中预防的循证回顾：神经外科的观点

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In this paper, the authors' aim is to provide an evidence-based review of primary and secondary ischemic stroke prevention guidelines covering most of the common risk factors and stroke etiologies for the practicing neurosurgeon. The key to stroke prevention is in the identification and treatment of the major risk factors for stroke. These include hypertension, heart disease, diabetes mellitus, dyslipidemia, and tobacco smoking. An updated approach to secondary prevention of stroke in the setting of intracranial and extracranial large vessel atherosclerosis and cardioembolism is provided along with a brief overview of pertinent clinical trials. Novel pharmacological options for prevention of cardioembolic strokes, such as new alternatives to warfarin, are addressed with recommendations for interruption of therapy for elective surgical procedures. In addition, the authors have reviewed the anticoagulation guidelines and the risk of thromboembolic complications of such therapies in the perioperative period, which is an invaluable piece of information for neurosurgeons. Less common etiologies such as arterial dissections and patent foramen ovale are also briefly discussed. Finally, the authors have outlined the quality measures in the Medicare Physician Quality Reporting System and essential guidelines for Primary Stroke Center certification, which have implications for day-to-day neurosurgical practice.
机译：在本文中，作者的目的是对初级和次级缺血性卒中预防指南进行循证审查，该指南涵盖了神经外科医师的大多数常见危险因素和卒中病因。预防中风的关键在于识别和治疗中风的主要危险因素。这些包括高血压，心脏病，糖尿病，血脂异常和吸烟。提供了颅内和颅外大血管粥样硬化和心脏栓塞的中风二级预防的更新方法，并简要概述了相关临床试验。提出了用于预防心脏栓塞性中风的新药理选择，例如华法林的新替代品，并提出了中断选择性外科手术治疗的建议。此外，作者还回顾了抗凝指南以及围手术期此类疗法的血栓栓塞并发症风险，这对于神经外科医生来说是无价的信息。还简要讨论了较不常见的病因，例如动脉夹层和卵圆孔未闭。最后，作者概述了《 Medicare医师质量报告系统》中的质量措施和初级卒中中心认证的基本准则，这些准则对日常的神经外科实践具有重要意义。

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