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

Secondary prevention for specific causes of ischemic stroke

Cause of ischemic stroke	Revascularisation	Multifacrorial risk reduction
Large vessel atherosclerosis Carotid artery stenosis and occlusion Intracranial artery atheroscerosis Vertebral artery stenosis Extracranial artery dissection
Small vessel disease
Cardiac embolism Atrial fibrillation Recent Myocardial infarction Cardiac failure Dilated cardiomyopathy Valvular heart disease Rheumatic heart disease Prosthetic heart disease
Blood Dyscrasias Inherited thrombophilias Sickle cell disease Antiphospholipid syndrome

A) Revascularization [carotid artery occlusion, stenosis, vertebral artery stenosis, intracranial large artery atherosclerosis,

• Carotid endartectomy :prefferd
• Carotid stenting

B)Multifactorial risk reduction

• Antiplatelet agents
• Antilipid
• Antihypertensive med

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.)