Treatment of specific stroke types

Ischemic Stroke type Recommendations
Atherosclerotic carotid disease
>70% stenosis Carotid endarterectomy of definite benefit if done with acceptable morbidity and mortality + antiplatelet agent
50 to 69% stenosis Carotid endarterectomy of potential benefit depending on risk factors + Antiplatelet agent
<50% stenosis Carotid endarterectomy of no benefit. Use Antiplatelet agents
Intracranial artery stenosis

50 to 99% stenosis of an intracranial artery

(carotid, anterior, middle, posterior, vertebral or basilar) 

Antiplatelet Agent  (The Warfarin Aspirin Symptomatic Intracranial Disease Study. Neurology. 1995 Aug;45(8):1488-93.)

Cardiac embolism
Emboli source: Oral anticoagulation (unless contraindicated):
Nonvalvular atrial fibrillation Warfarin, INR 2-3 (target 2.5) lifelong therapy
Left ventricular thrombus, recent Myocardial infarction Warfarin, INR 2-3 (target 2.5) 6-month therapy
Prosthetic Valvular heart disease Warfarin, INR 3-4 (target 3.5) lifelong therapy
Possible cardiac source but not sure Antiplatelet agents
Extracranial artery dissection
CVA or TIA from artery dissection
  • AHA/ASA guidelines issued in 2006: use of either warfarin for three to six months or the use of antiplatelet agents is reasonable
  • Need follow up with imaging study, to see whether dissection is healed or thrombosed
Recurrent ischemic events despite adequate antithrombotic therapy Stenting may be considered
Positive antiphospholipid antibodies
Does not meet criteria for Antiphospholipid Antibody syndrome Antiplatelet agents
Meet criteria for antiphospholipid antibody syndrome
(venous and arterial occlusive disease in multiple organs,
miscarriages and livedo reticularis)		 Warfarin with target INR 2-3
Other infarct types
Small-vessel lacunar disease and cryptogenic stroke Antiplatelet agents