SECONDARY PREVENTION OF SMALL SUBCORTICAL STROKES (SPS3)

皮质下小卒中(S3)是一种重要的卒中亚型，约占所有缺血性卒中的25%。在西班牙裔美国人中，S3是最常见的中风亚型，发生在相对年轻的年龄。S3通常是由于大脑小动脉疾病，这是血管性痴呆的常见底物。超过200万的S3幸存者有复发中风和血管性痴呆症的高风险；还有数百万人患有亚临床S3和由以下原因导致的认知能力下降 大脑小动脉疾病。皮质下小卒中的二级预防(SPS3)由两个随机的多中心临床试验组成，这两个试验是在NINDS赞助的为期3年的试点研究之后进行的。它将招募2500名参与者(其中20%将是西班牙裔美国人)，他们有症状，MRI定义的3美元，在35个临床地点没有颈动脉狭窄或主要心脏栓塞源。患者将以析因设计被分配到两种干预措施中： 1.抗血小板干预325 mg/d与阿司匹林325 mg/d+氯吡格雷75 mg/d比较。 2.血压干预：收缩压目标为130~149毫米汞柱与130毫米汞柱。 抗血小板对照将是双盲的，而血压干预将开放标签，对认知和临床事件进行盲目评估和验证。随访时间为每三个月一次，平均为3年。 主要成果是： 1.复发性中风(缺血性和出血性) 2.认知功能衰退 3.重大血管事件 关键假设是：1.在预防中风复发和减少认知衰退方面，联合抗血小板治疗比单用阿司匹林更有效。2.加强血压控制与减少中风复发和减少认知功能衰退有关。 3.与非西班牙裔白人参与者相比，拉美裔美国人的中风和认知能力下降的绝对减少程度在联合抗血小板治疗和(单独)强化降压方面效果更好。以前还没有随机试验专门关注S3之后的二级预防，中风后血压控制的最佳目标水平及其与认知能力下降的关系，或者中风和痴呆的预防。 拉美裔美国人。SPS3的结果可能会大大减轻数百万S3患者，特别是拉美裔美国人的严重神经系统疾病(中风和血管性痴呆症)的负担。

Small subcortical strokes (S3) are an important stroke subtype that account for about 25% of all ischemic strokes. In Hispanic Americans, S3 are the most frequent stroke subtype and occur at a relatively young age. S3 are usually due to cerebral small artery disease, a common substrate for vascular dementia. Over two million survivors of S3 are at high risk for recurrent stroke and for vascular dementia; millions more suffer subclinical S3 and cognitive decline caused by cerebral small artery disease. Secondary Prevention of Small Subcortical Strokes (SPS3) consists of two randomized, multicenter clinical trials that follow a 3 year NINDS-sponsored pilot study. It will enroll 2500 participants (20% of whom will be Hispanic Americans) with symptomatic, MRI-defined $3 without carotid stenosis or major cardiac sources of embolism at 35 clinical sites. Patients will be assigned, in a factorial design, to two interventions: 1. Antiplatelet Intervention 325 mg/d vs aspirin 325 mg/d plus clopidogrel 75 mg/d. 2. Blood Pressure Intervention: systolic blood pressure targets of 130 to 149 mmHg vs <130 mmHg. The antiplatelet comparison will be double-blinded, while the blood pressure intervention will open-label with blinded assessment and verification of cognition and clinical events. Follow-up will be every three months for a mean of 3 years. Main outcomes are: 1. recurrent stroke (ischemic and hemorrhagic) 2. cognitive decline 3. major vascular events Key hypotheses are: 1. Combination antiplatelet therapy is more efficacious than aspirin alone for prevention of stroke recurrence and for reduction in cognitive decline. 2. Intensive blood pressure control is associated with fewer recurrent strokes and reduction in cognitive decline. 3. The absolute reduction in stroke and cognitive decline by combined antiplatelet therapy and (separately) by intensive blood pressure lowering is greater for Hispanic Americans vs. non Hispanic white participants. No previous randomized trials have focused specifically on secondary prevention after S3, on optimal target levels of blood pressure control after stroke and their relationship to cognitive decline, or on prevention of stroke and dementia in Hispanic Americans. The results of SPS3 will likely lead to important reduction in the burden of serious neurological disease (stroke and vascular dementia) for millions of people with S3, and particularly for Hispanic Americans.