Cerebrovascular disorders: carotid-wall intima-media thickness, stroke recurrence, and β-blocker selectivity

Excerpt

It is always amazing to see how many articles are published in the field of cerebrovascular disorders every month, even in very high-ranking journals. This is most certainly justified because daily clinical practice shows how relevant cerebrovascular disorders are. The three articles discussed in this month’s Journal Club primarily focus on primary or secondary prophylaxis. In the first study published in the New England Journal of Medicine, intima-media thickness of the walls of the common carotid artery and internal carotid artery, as well as the presence of plaque, were identified as a predictor for cardiovascular outcomes. The second article deals with stroke recurrence within the time window recommended for carotid endarterectomy, i.e. within 2 weeks after the first stroke due to a carotid stenosis. The article shows that early recurrent stroke risk was indeed high, particularly within the first 72 h, which has a considerable clinical impact. The final article, a systematic review on the effects of β-blocker selectivity on blood pressure variability and stroke also has clinical implications: non-selective β-blockers should be avoided in neurologic practice. In other words, β1-selective blockers can be used with the exception of atenolol, which has been shown not to be effective for stroke prevention. …