Clinical analysis in older patients with a first-ever, second, third, and recurrent strokes

Introduction : Recently, recurrent ischemic stroke has attracted significant attention in both research and clinical settings. Aim : A comparative retrospective analysis of risk factors and clinical characteristics in elderly patients (≥65 years) experiencing a first-ever, second, third, and recurrent cerebral infarction. Materials and methods : This study included 260 patients with acute stroke admitted to the Neurology Clinic. Patients were classified into three groups: Group 1—first-ever stroke (n=212), Group 2—second stroke (n=35), and Group 3—third and subsequent stroke (n=13). A model focused on the most common vascular risk factors, etiological classifications, and assessment scales. Clinical, instrumental, and statistical methods were applied. Results : Two independent risk factors with strong prognostic relevance were identified: age and dyslipidemia (noted specifically between Group 1 and Group 2). Clinically important comorbidities with moderate impact on vascular risk included arrhythmias and conduction disorders, other cardiovascular diseases, and diabetes mellitus. No statistically significant differences were found among the three groups with respect to sex, arterial hypertension, smoking status, or affected vascular territories. The main TOAST criteria were large-artery atherosclerosis, cardioembolism, and small-vessel disease. Among patients in Groups 2 and 3, phenotypes A1, A2, S3, C1, and C2 (ASCOD) were identified as significant etiological factors. The incidence of subsequent cerebrovascular events was 18.46%. Conclusion : Recurrence of ischemic stroke is a significant barrier to the development of effective, long-term prognostic models, the implementation of secondary prevention strategies, and the advancement of therapeutic paradigms.