Stroke is a common and serious disorder, and is a leading cause of disability and death in adults. Transient ischaemic attacks are now recognised as being common precursors of
stroke, with a high risk of subsequent vascular events. The majority of
strokes are ischaemic in origin, and are typically due to athero-
thrombosis/microatheromatosis involving a large or small cerebral blood vessel or to an embolic event. Owing to the diffuse nature of
atherothrombosis, these patients are at risk of ischaemic events in other vascular beds. Options for treating patients with acute
ischaemic stroke are very limited; therefore prevention is a key strategy for reducing the risk of recurrent
stroke and other vascular events. Treatment of risk factors such as
hypertension,
diabetes mellitus, smoking and
obesity is an important approach for
stroke prevention. Platelets are involved in the development of thrombi and emboli, making antiplatelet
therapy an important preventive strategy.
Antiplatelet agents are effective in preventing recurrent
ischaemic stroke and other vascular ischaemic events, such as
myocardial infarction and vascular death. In some cases,
anticoagulants may be effective in preventing
ischaemic stroke recurrence.
Carotid endarterectomy can reduce
stroke risk in patients with moderate- or high-grade
carotid artery stenosis. Choosing the most appropriate
therapy for the individual patient is key to optimising
stroke prevention.