Prevention of ischemic stroke

Created 13/09/2023, last revision 19/09/2023

primary stroke prevention – interventions to reduce the risk of stroke in asymptomatic individuals
secondary stroke prevention – interventions to reduce the risk of recurrent ischemic stroke in individuals who have already experienced a stroke or TIA; the management is based on the etiology of the previous ischemic stroke and takes into account individual vascular risk factors

Stroke prevention involves:

initial vascular risk stratification (to assess an individual’s likelihood of experiencing a cardiovascular event) – analyze risk factors + personal medical history (previous stroke or another cardiovascular event)
- SCORE2 (Systematic COronary Risk Evaluation) – a risk stratification tool used primarily in Europe to estimate the 10-year risk of fatal atherosclerotic cardiovascular disease (CVD), including stroke
- Framingham Risk Score (focuses on the risk of coronary disease)
- ASCVD (Atherosclerotic Cardiovascular Disease) Risk Calculator – used for primary prevention
- CHA₂DS₂-VASc Score (risk of stroke in patients with atrial fibrillation)
management of vascular risk factors
antithrombotic therapy
- antiplatelet agents – aspirin, clopidogrel, ticagrelor, or their combinations (DAPT) are commonly used
- anticoagulation therapy – for those with cardioembolic risk factors (most commonly atrial fibrillation)
surgical and endovascular procedures
- carotid endarterectomy or angioplasty with stenting on extracerebral and cerebral arteries
- PFO closure, LAA closure, pulmonary AV shunt occlusion, RF ablation, cardiac surgery, etc.
regular monitoring and adherence to treatment are crucial