Ischemic stroke secondary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Secondary Prevention

Life style modification for secondary prevention

Life style modification measures which may help reduce the risk of recurrent stroke and prevent complications may include:

• Increased physical activity
• Eating healthy balanced diet
• Smoking cessation
• Decreased alcohal intake

Treatment of modifiable risk factors

• Treatment and maintainence of hypertension, diabetes mellitus and hyperlipidemias
• Treatment of underlying coronary artery disease
• Treatment of atrial fibrillation and maintaining anticoagulant prophylaxis in high risk patients
• Proper management and follow up of genetic hypercoaguable conditions
• Use of long term antiplatelet therapy such as aspirin, clopidogrel or combination therapy may be used to prevent recurrent ischemic stroke.

For AHA/ASA guidelines for prevention of stroke, please click here

Secondary prevention for specific causes of ischemic stroke

Cause of ischemic stroke		Revascularization			Multifactorial risk reduction
		Carotid endartectomy	Carotid stenting	Other Surgical options	Antiplatelet therapy	Statins	Antihypertensives	Anticoagulants
Large artery disease	Carotid Artery Stenosis	✔	✔
	Carotid occlusion		✔					✔
	Vertebral artery stenosis			Angioplasty	✔	✔	✔
	Large vessel atherosclerosis		✔	Percutaneous transluminal angioplasty	✔✔	✔✔	✔✔	✔✔
	Arterial dissection			Endovascular surgical repair	✔			✔
Cardiac embolism	Atrial fibrillation
	Valvular heart disease
	Recent MI
	Heart failure
	Dilated cardiomyopathy
Hypercoaguable states	Protein C/S deficiency
	Sickle cell disease
	Antithrombin III deficiency

Treatment of risk factors in patients who have already had strokes (secondary prevention) is also very important as they are at high risk of subsequent events compared with those who have never had a stroke. Medication or drug therapy is the most common method of stroke prevention. Aspirin (usually at a low dose of 75 mg) is recommended for the primary and secondary prevention of stroke. Also see Antiplatelet drug treatment. Treating risk factors like hypertension, diabetes mellitus, smoking cessation, control of hypercholesterolemia, physical exercise, and avoidance of illicit drugs and excessive alcohol consumption are all recommended ways of reducing the risk of stroke in a patient who already has a history of previous strokes.

In patients who have strokes due to abnormalities of the heart, such as atrial fibrillation, anticoagulation with medications such as warfarin is often necessary for stroke prevention.

Procedures such as carotid endarterectomy or carotid angioplasty can be used to remove significant atherosclerotic narrowing (stenosis) of the carotid artery, which supplies blood to the brain. These procedures have been shown to prevent stroke in certain patients, especially where carotid stenosis leads to ischemic events such as transient ischemic attack. (The value and role of carotid artery ultrasound scanning in screening has yet to be established.)