Stroke Prevention and Recurrence

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What percentage of risk does the patient have of having a secondary stroke?

60-70%

10-20%

25-35% (correct)

40-50%

What was the annual stroke recurrence rate in the 2000s?

10%

5% (correct)

What percentage of strokes can be prevented according to the American Heart Association/American Stroke Association?

The overwhelming majority (correct)

90%

50%

70%

What is the percentage of population-attributable risk for ischemic and hemorrhagic stroke accounted for by five factors in the INTERSTROKE study?

82% Signup and view all the answers

What is the cumulative risk reduction for recurrent vascular events with the use of aspirin or clopidogrel and lifestyle changes?

80% Signup and view all the answers

Why do stroke survivors remain at risk for secondary strokes?

Poor control of vascular risk factors Signup and view all the answers

In patients with atrial fibrillation, what should be initiated as soon as it is safe to do so?

A direct oral anticoagulant (DOAC) Signup and view all the answers

What is the recommended daily sodium intake for patients with hypertension who experience a stroke or TIA?

Less than 1g/d sodium (2.5 g/d salt) Signup and view all the answers

What type of diet is recommended for patients with stroke or TIA to reduce the risk of recurrent stroke?

Mediterranean-type diet Signup and view all the answers

What is the recommended exercise routine for patients with stroke or TIA?

At least 10 minutes of moderate exercise 4 times a week Signup and view all the answers

What is the recommended blood pressure target for suitable patients with hypertension who experience a stroke or TIA?

< 130/80 mm Hg Signup and view all the answers

What is the recommended intervention for patients with a history of substance use disorders?

Referral to specialist help Signup and view all the answers

What is the recommended multidisciplinary approach for patients with ischemic stroke or TIA?

Care provision with advanced practice providers, nurses, or pharmacists Signup and view all the answers

What is the recommended treatment for patients with severe carotid stenosis of 50-99%?

Carotid endarterectomy Signup and view all the answers

Why should patients with large ischemic strokes delay initiation of direct oral anticoagulant (DOAC)?

To allow for hemorrhagic transformation of the infarct Signup and view all the answers

What is the recommended lifestyle modification for patients with ischemic stroke or TIA?

All of the above Signup and view all the answers

What is the primary goal of a diagnostic evaluation in patients with ischemic stroke or TIA?

To fully understand the etiology and prevent recurrent stroke Signup and view all the answers

How soon should testing be initiated and ideally completed in patients with ischemic stroke or TIA?

Within 48 hours of onset of symptoms Signup and view all the answers

What is the primary purpose of ECG in patients with suspected stroke or TIA?

To screen for atrial fibrillation and atrial flutter Signup and view all the answers

What is the purpose of blood tests in patients with confirmed stroke?

To gain insight into risk factors for stroke and inform therapeutic goals Signup and view all the answers

What imaging modality is used to identify atherosclerotic disease, dissection, moyamoya, or other etiologically relevant vasculopathies?

Computed tomography angiography (CTA) or magnetic resonance angiography (MRA) Signup and view all the answers

What is the primary purpose of echocardiography in patients with cryptogenic stroke?

To evaluate for possible cardiac sources of or transcardiac pathways for cerebral embolism Signup and view all the answers

What is the primary purpose of long-term cardiac rhythm monitoring in patients with cryptogenic stroke?

To detect intermittent atrial fibrillation Signup and view all the answers

What is the purpose of genetic testing in some patients with ischemic stroke or TIA?

To consider inherited diseases associated with stroke, such as CADASIL or CARASIL Signup and view all the answers

What is the primary purpose of transesophageal echocardiography (TEE) in patients with embolic stroke of unknown source (ESUS)?

To identify possible cardioaortic sources of or transcardiac pathways for cerebral embolism Signup and view all the answers

What imaging modality is used to detect embolus detection resulting from a right to left shunt in patients with confirmed ischemic stroke or TIA and patent foramen ovale (PFO)?

Transcranial Doppler (TCD) Signup and view all the answers

What is the primary goal of using stroke quality measures in hospitals?

To improve patient outcomes Signup and view all the answers

Which of the following is NOT a core area covered by stroke quality measures?

Rehabilitation care Signup and view all the answers

What is the recommended duration of in-hospital stroke rehabilitation for Adaibaa?

6-8 weeks Signup and view all the answers

What is the risk of recurrent stroke in stroke patients?

25-35% Signup and view all the answers

What is the recommended cumulative risk reduction for recurrent vascular events?

80% Signup and view all the answers

What is the recommended time frame for diagnostic evaluation in patients with ischemic stroke or TIA?

Within 48 hours Signup and view all the answers

What is the primary goal of enrolling patients in quality monitoring and improvement programs upon discharge?

To control vascular risk factors Signup and view all the answers

What is the recommended initial step in an acute stroke presentation?

Activating the stroke alert Signup and view all the answers

What is the standard of care for acute stroke assessment?

Unenhanced CT imaging Signup and view all the answers

What is the recommended approach to managing stroke care in conjunction with person-centered care?

Implementing stroke quality measures Signup and view all the answers

Study Notes

Stroke Prevention and Management

A stroke survivor has a 25-35% risk of having a secondary (recurrent) stroke, but this risk can be mitigated with appropriate secondary stroke prevention measures.
Research has shown that the annual stroke recurrence rate has decreased from 8.7% in the 1960s to 5% in the 2000s, largely due to improved blood pressure control and use of antiplatelet therapy.

Risk Factors and Prevention

The American Heart Association/American Stroke Association states that the majority of strokes can be prevented through blood pressure control, a healthy diet, regular physical activity, and smoking cessation.
Five factors - blood pressure, diet, physical inactivity, smoking, and abdominal obesity - account for 82% and 90% of the population-attributable risk for ischemic and hemorrhagic stroke, respectively.
Targeting multiple risk factors is critical to secondary prevention, and studies have shown that using aspirin or clopidogrel, along with dietary changes and increased physical activity, can lead to a cumulative risk reduction of 80% for recurrent vascular events.

Diagnostic Evaluation

In patients who have had an ischemic stroke or TIA, a diagnostic evaluation is recommended to understand the etiology and to optimize the care plan to prevent recurrent stroke.
Testing should be initiated and ideally completed within 48 hours of symptom onset.
Diagnostic evaluation options include:
- CT or MRI of the brain to confirm the diagnosis of symptomatic ischemic cerebral vascular disease
- ECG to screen for atrial fibrillation and other concomitant cardiac conditions
- Blood tests to gain insight into risk factors for stroke and to inform therapeutic goals
- Non-invasive imaging of the intracranial large arteries and imaging of the extracranial vertebrobasilar arterial system
- Radiology to screen for stenosis

Treatment and Management

Patients with a TIA or minor (non-disabling) ischemic stroke should be initiated on dual antiplatelets, then continued on clopidogrel alone thereafter.
Patients with a disabling acute ischemic stroke should be treated with aspirin 300mg for 2 weeks initially.
Patients with atrial fibrillation should be commenced on a direct oral anticoagulant (DOAC) as soon as it is safe to do so.
All patients with an acute ischemic stroke should be commenced on a high-intensity statin.
Carotid endarterectomy may be suitable for patients with severe carotid stenosis of 50-99% on the same side as the part of the brain affected.

Lifestyle Modifications

Patients who have had a stroke or TIA should be advised to follow a Mediterranean-type diet.
Reducing sodium intake by at least 1g/d sodium (2.5g/d salt) can reduce the risk of cardiovascular disease events including stroke.
Exercise can lower the risk of recurrent stroke and the composite cardiovascular end point of recurrent stroke, myocardial infarction, or vascular death.
Smoking cessation should be encouraged with referral to specialist help if required.
Men who drink > 2 alcoholic drinks a day or women who drink > 1 alcoholic drink a day should be counseled to eliminate or reduce their consumption of alcohol to reduce stroke risk.

Quality Measures and Follow-up

Enrolment in quality monitoring and improvement programs is recommended for patients with ischemic stroke or TIA upon discharge.
A multidisciplinary outpatient team-based approach can be effective in controlling blood pressure, lipids, and other vascular risk factors.
Stroke quality measures have been developed to standardize stroke care among hospitals, and using these performance metrics can help improve stroke care and ultimately lead to improved outcomes for patients.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers the prevention and recurrence of strokes, including the risks and measures to mitigate them. Learn about the importance of blood pressure control and antiplatelet therapy in reducing the risk of recurrent strokes.