Dual antiplatelet therapy has been widely used for the secondary prevention in patients with minor stroke and high-risk transient ischemic attack (TIA). Currently, the commonly used antiplatelet drugs are aspirin and clopidogrel. The therapeutic effect of antiplatelet drugs varies among individuals, namely platelet resistance. Among them, aspirin resistance is often caused by poor drug compliance, while clopidogrel resistance is often associated with CYP2C19 allele mutations. Patients with minor stroke and high-risk TIA carrying CYP2C19 loss-of-function alleles have poor preventive effects when using clopidogrel. Early screening of the CYP2C19 loss-of-function alleles and targeted measures can benefit such patients. This article reviews the research progress on the selection of antiplatelet therapy for minor stroke or high-risk TIA patients carrying the CYP2C19 loss-of-function alleles.

Stroke has a high morbidity,disability and mortality.Early identification and intervention of carotid atherosclerotic plaque can prevent the occurrence of stroke.Studies have shown that atherosclerotic plaques are closely related to immune-mediated inflammation,and targeted inflammation therapy is expected to become a new method for the treatment of atherosclerotic plaques.This article systematically reviewed the role of immune regulatory mechanisms of different cells in the inflammatory response of atherosclerotic plaques,as well as potential targeted anti-inflammatory drugs,in order to provide reference for the clinical treatment of atherosclerosis related diseases.

Objective To analyze the application value and clinical experience of intraoperative ultrasound in microsurgical resection of supratentorial cavernous malformations.Methods From March 2018 to March 2019,31 patients with supratentorial cavernous malformations were operated with assistance of intraoperative ultrasound in our hospital.Intraoperative ultrasound could clearly show the locations and sizes of the lesions,and relations of lesions with surrounding structures to choose appropriate surgical routes.The degrees of resection were judged and complications were recorded.The patients were followed up for 3-6 months,and modified Rankin scale (mRS) was used to evaluate the prognoses.Results In these 31 patients,35 cavernous hemangiomas were diagnosed by MR imaging before surgery;33 lesions were removed surgically,and the other two lesions located in the contralateral side of the operative field were not removed.The accuracy of intraoperative ultrasound guiding the lesions was up to 100％.There were no postoperative infections or deaths.During follow-up,mRS score of 28 patients was 0;the other 3 patients with postoperative neurological impairment recovered partially during follow-up.Conclusion With the help of real-time monitoring of intraoperative ultrasound and location technique of small pieces of hemostatic yam,patients with supratentorial cavernous malformations could acquire satisfactory prognosis through meticulous microsurgery.