Repeated ischemic stroke and its prevention

Stroke is the world’s 2 nd – 3 rd leading cause of death and mortality. The risk of stroke is much greater for survivors of stroke. Survivors of a transient ischemic attack (TIA) or ischemic stroke are at higher risk of recurrent stroke during the interval between a few days or weeks and several years after the first event. Risk factors for ischemic stroke include hypertension, diabetes, hyperlipidemia, etc. The highest rate of recurrent stroke is observed in large artery atherosclerosis (atherothrombotic stroke) and cardioembolic stroke, while a recurrent stroke most often relates to the same subtype. A lacunar stroke is noted to have a lower recurrence rate, and a recurrent stroke may have a subtype that is different from the first one. In a recurrent stroke, neurological damage is usually more severe and harder to deal with. Patients with recurrent stroke have a higher mortality rate compared with patients with the first stroke. Secondary prevention is crucial to reduce recurrent ischemic stroke rates. To identify CVD risk factors is the initial priority when focusing efforts on secondary prevention. Lifestyle modifications, including tobacco cessation, decreased alcohol use, and increased physical activity, are also important in the management of patients with a history of stroke or transient ischemic attack. Optimal pharmacotherapeutic preventive strategies should be tailored to the specific stroke subtype. Antiplatelet therapy is recommended to reduce the risk of recurrent ischemic stroke, and its choice should be based on treatment duration, safety, efficacy, the cost of the drug, and patient characteristics and preferences.