Blood pressure remains the single most important modifiable risk factor for the primary and secondary prevention of stroke. The landmark trial of the Perindoprii Protection Against Recurrent Stroke Study (PROGRESS) has suggested that the antihypertensive treatment with angiotensin-converting enzyme inhibitor (ACEI) perindopril at least 2 weeks after stroke may reduce the risks of recurrent stroke and other cardiovascular events. Although most systematic reviews have suggested that the efficacy of almost all types of antihypertensive drugs is similar in the prevention of stroke,there are also some important exceptions. The Ongoing Telmisartan Alone and in Combination with Ramipril Global End point Trial (ONTARGET) has demonstrated that the angiotensin receptor blockers (ARB) telmisartan was equivalent to ramipril for preventing cardiovascular events in patients with vascular disease or diabetes; while in a similar population,ramipril was quite effective for preventing stroke. It is speculated according to the moderating effects of ARB on the renin-angiotensin-aldosterone system that its protective effects against stroke is superior to other antihypertensives. However,many clinical trials have suggested that ARB does not have unique role in stroke prevention. Therefore,whether ARB should be regarded as the first-line drags for stroke prevention in both primary and secondary prevention settings has been controversial.

The evidence from epidemiological and observational studies support that homocysteine is an important risk factor for ischemic stroke. Using folic acid and vitamins B to reduce homocysteine may effectively prevent ischemic stroke. However, the results of the vast majority of clinical trials are negative. This article analyzes them.

How to choose and implement antithrombotic therapy has always been a controversial issue in the primary and secondary prevention of cardiac embolic stroke in patients with atrial fibrillation in clinical practice. This article synthesizes the recent literatures and discusses them.

There has been controversies on whether using intravenous or intraarterial thrombolytic therapy around the onset of acute ischemic stroke within 3 hours.This article summarizes the main arguments of different neurologists.

dence is weak. And whether it is ethical to have a placebo arm in reperfusion trials in the 3- to 6-hour time window remains controversy. This article discusses them.

Carotid artery and coronary atberosclcrotic lesions often coexist. How to manage the two kinds of lesions, especially to reduce the risk of perioperative stroke, whether it is necessary to treat carotid artery lesions first or simultaneously before coronary artery bypass grafting, and whether stent angioplasty can replace carotid endarterectomy in the treatment of carotid disease has been controversial. This article discusses them.

Carotid stenosis is an important risk factor for isehemie stroke. For many years, there have been controversies surrounding how to treat carotid artery stenosis, and then effectively realize stroke prevention. This article analyzes them.

Cerebral venous sirras thrombosis is rare clinical practice, but there has been controversial as to whether anticoagulant therapy should be performed or not. The bone of contention is whether anticoagulant therapy is safe and effective indeed. This article discusses the above problem.

With the continuous improvement of drag for stroke prevention, ipsilateral stroke risk in patients with asymptomatic carotid stenosis has been equal to or lower than that in the revascularization group in randomized controlled trials. Under this condition, is the asymptomatic severe carotid stenosis an indication for revascularization? This article introduces the views of different researchers.

Neuroimaging studies show that transient ischemic attacks of middle cerebral artery occlusion are not uncommon.Whether these patients should be treated with tissue plasminogen activator remains to be controversial.This article introduces the different views around this debate.