AAN: Medication, exercise more beneficial than stent in preventing stroke

Medication and exercise are more beneficial in preventing a second stroke in those with intracranial atherosclerosis compared with placement of a blood vessel stent, new guidance from the American Academy of Neurology stated.

AAN’s practice advisory reviewed available research on preventing a second stroke or death in those who had a first stroke because of intracranial atherosclerosis. The published advisory was endorsed by the American Heart Association/American Stroke Association, Neurocritical Care Society and Society of Vascular and Interventional Neurology.

“People who have had this type of stroke should first be started on medications to prevent blood clots, reduce blood pressure and cholesterol and safely start increasing their physical activity as recommended by their doctors to decrease the risk of another stroke,” Tanya Turan, MD, MSCR, author of the practice advisory and AAN fellow, said in a press release. “Having a stent placed in the blood vessel of the brain should not be the first option of care for most people.”

Currently, the two approaches for preventing stroke in those with narrowing brain arteries are placement of a stent or medical management through medication and exercise.

“Reviewing all of the evidence that has accumulated over the last 2 decades, we found that the research shows that medical management is more beneficial for people as an initial treatment,” Turan said.

The practice advisory further recommends the use of aspirin for long-term prevention of a second stroke or death, and if the narrowing of the arteries is more severe, the addition of clopidogrel with aspirin for up to 90 days.

To achieve an LDL cholesterol of less than 70 mg/dL, the practice advisory recommends the use of statins, which would also help achieve a long-term blood pressure of less than 140/90 mm Hg. Moderate physical activity is also recommended.