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)
  • 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

For an overview of vascular risk factors, see here and here

Cardiovascular disease risk predictors


  • dyslipidemia
  • hypolipidemic agents
    • statin-induced myopathy and intolerance

Arterial hypertension (HTN)

Other risk factors

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Prevention of ischemic stroke