Prevention

Give patients with suspected ischaemic stroke aspirin within 48 hours ^a or as soon as an intracranial haemorrhage has been excluded. ^d  

Consider adding dipyridamole. ^a

Alternatives include

• clopidrogel ^a  
• ticlopidine ^a  

There is no clear benefit from

• immediate anticoagulation ^d  
• indobufen ^a
• hormone replacement therapy ^a

Give an ACE inhibitor ^a with indapamide if tolerated. ^a 

Treat stroke risk factors

• hypertension ^a  
  There is no clear benefit from altering blood pressure early ^d  
• high cholesterol using a statin ^a 

• stop smoking ^a  
• eat more fruit and vegetables ^a

Carotid endarterectomy

Consider performing carotid endarterectomy in patients with carotid stenosis > 50% ^a

• using patch angioplasty ^a
• Give patients low-dose aspirin ^a  

Avoid carotid endarterectomy for patients with a carotid stenosis < 50% ^a  

An alternative is endovascular treatment using angioplasty and stenting. ^a

There is no clear benefit from

• shunting ^d  
• local anaesthetic ^d
• eversion endarteretomy ^d

• increasing age ^b  
• female sex ^b
• non-elective admission ^b  
• associated stroke risk factors  
  • atrial fibrillation ^b  
  • congestive heart failure ^b  
  • hypertension ^b  
  • a recent stroke or TIA ^b  particularly if more severe ^b  
• associated cardiovascular disease
  • history of angina ^b  or a recent MI ^b  
  • peripheral vascular disease ^b  
  • mitral or aortic valve disease ^b  
• diffuse carotid artery stenosis ^b  
• no antiplatelet cover during surgery ^b  
• low annual operating volumes for surgeons and hospitals ^b and the surgeon's place of training ^b