<International Circulation>：Do you have any suggestions for strategies in stroke management in the general population? What kinds of problems should we be paying attention to?

　　《国际循环网》：请问您在卒中治疗策略方面对大家有什么建议？有什么需要特别注意的问题吗？
Dr. Koroshetz: Stroke is very heterogeneous and to lump strokes together， one misses the opportunity to find the best treatment for the patient. To treat the patient correctly you have to know the pathology underlying the stroke risk. This is an exact science， but there are a couple of major causes of stroke followed by many causes of rare stroke. To get at the right treatment， you have to know how to classify stroke accurately.

　　Dr. Koroshetz:卒中种类多种多样，如果混为一谈，会失去使用最佳方法治疗患者的机会。为了正确的治疗患者，你必须了解卒中发生风险的病理生理机制。这是一门精确的科学，但是，卒中发生有常见主要原因，同时也会有很多原因导致罕见卒中发生。为了正确的治疗卒中，我们必须对卒中进行准确分类。

<International Circulation>：What are you strategies from classification?

　　《国际循环网》：关于卒中分类，您有何高见？
Dr. Koroshetz:The most common strokes are divided into large artery atherothrombosis. The same type of patients who have coronary artery disease or peripheral artery disease， those with atherosclerotic build up have multi-focal appearances. With Caucasians， these are frequently found in the neck. In Asians and African Americans， these are more likely to occur intracranially. Even there， we have different treatments， depending on the location of stenosis. We are currently in a trail of intracranial stenting for atherosclerosis inside the head vessels. We found， interestingly， that aggressive medical therapy had a dramatic benefit. The stenting procedure was found to be inferior to medical therapy.

　　Dr. Koroshetz: 最常见的卒中是由大动脉的粥样斑块栓子脱落引起，这种卒中类型与有冠心病或周围血管疾病的患者发生的卒中类型相同。这些患者全身多处有动脉粥样硬化斑块形成。对于白种人（高加索人），粥样硬化斑块多发生于颈部。对于亚裔和非裔美国人，粥样硬化斑块多发生于颅内。根据狭窄不同部位，我们会采取不同治疗方法。我们正在进行颅内粥样硬化动脉的血管支架置入试验。有趣的是，我们发现积极药物干预会使患者获益很多。血管支架置入效果劣于药物干预。

<International Circulation>： What drugs are you using in this kind of therapy?

　　《国际循环网》：:在治疗过程中您应用什么药物呢？
Dr. Koroshetz:We stumbled on this finding because we had previously performed a study of anti-coagulants， warfarin， versus aspirin. We found that they were both equivalent in terms of protection， but the nature history was quite scary. There was a very high risk of stroke. When we performed a second study， stenting with aggressive medical therapy—aggressive blood pressure control， aggressive lipid control—because in the first study， they found that patients with the highest blood pressure had the greatest risk of recurring stroke. They decided to significantly lower the blood pressure. Many thought this was counter intuitive. If you had a stenosis， and the blood cannot get passed， the last thing you would want to do is lower the blood pressure to force the blood through. In fact， it turned out it had a big effect， much larger than the stent effect. In addition， it was not just the blood pressure. In medicine as practiced now， a patient goes to the doctor and is given a prescription to take home. In this trial， they contracted with a company that would call the patient to remind them to take their medication and even change their doses until their lipids and blood pressure were brought under control. The control was quite dramatic. There is a point to be made here: if we aggressively reduce the risk factors we know about， there can be a dramatic effect on occurrence of stroke.

　　Dr. Koroshetz:我们做过一项华法林和阿司匹林抗凝效果对比研究，发现了药物干预的好处，这两种药物在卒中预防和保护方面效果相同。虽然药物有保护作用，但卒中病程演进却令人恐惧，卒中发生率还是很高。我们又进行了第二项试验，血管支架置入联合积极药物干预，如严格血压和血脂控制。前一个试验中我们发现，患者血压高使卒中复发风险增加，我们决定把患者血压控制在较低水平。许多人觉得降压治疗有悖于我们的直觉。因为我们一直认为，如果血管存在狭窄，血流不畅，相对较高的血压才能使血流通过狭窄处，不到万不得已谁会选择降低血压呢？但事实证明积极的降压降脂等干预措施确实比血管内支架置入等好很多。当然，我们的干预措施不仅只有血压血脂控制，还包括患者求医，医生处方药物，带回家。试验中患者与公司达成协议，公司负责打电话提醒患者在合适的时间吃药，当患者血压血脂控制在较好水平时，提醒其改变药量。这个血压血脂的控制过程可能有起伏波动。因此，我们得出结论：如果我们积极降低已知危险因素，将对控制卒中发生产生重要影响。

Right now there is a lot controversy in the field over whether that type of aggressive therapy would have benefit that would overcome the need for endarterecomy or carotid artery stenting in people who do not have symptoms of carotid stenosis. There is a lot of interesting discussion in this area.

　　在卒中治疗方面，患者从积极医疗干预中获益是否优于动脉切开取栓或颈动脉内支架置入（没有颈动脉狭窄症状）获益还存在争议。在这个方面有许多有趣的讨论。