Recurrent & Secondary Stroke Prevention

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What are Recurrent and Secondary Prevention of Stroke?

A recurrent stroke, also known as a secondary stroke, occurs when someone who has already experienced a stroke or a transient ischemic attack (TIA) suffers another one. Recurrent strokes are more likely to result in severe disability or death compared to a first stroke, making their prevention and management critically important.

Secondary prevention of stroke focuses on reducing the risk of further strokes or TIAs (whether it is a second, third or subsequent event, rather than preventing the first occurrence), through a combination of lifestyle changes, medical treatments and long-term strategies. The aim is to reduce the risk of recurrence and improve overall health.

WHY IS IT IMPORTANT TO ADDRESS RECURRENT STROKES?

Individuals who have had a stroke are at a significantly higher risk of experiencing another, with approximately 1 in 5 stroke survivors in Europe facing a recurrent stroke within five years.
Addressing recurrent strokes is essential because many of these can be prevented. By working with your doctor, managing your risk factors, adopting a healthier lifestyle, and staying committed to your treatment plan, you can significantly reduce your risk and safeguard your health against future strokes and complications.

CAUSES AND RISK FACTORS

Every stroke survivor has their own set of factors that contributed to their first event. It is important to know that if you’ve had a stroke or TIA, your chance of having another one is higher. Understanding what puts you at risk is crucial to preventing it.

Similar to the risk factors for a first stroke, they can be categorized into two types:

Modifiable risk for recurrent stroke:

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HIGH BLOOD PRESSURE

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ATRIAL FIBRILLATION

SMOKING AND VAPING

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HEART DISEASE

DIABETES

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HIGH CHOLESTEROL

PHYSICAL INACTIVITY

OBESITY

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CARTOTID OR OTHER ARTERY DISEASE

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CERTAIN BLOOD DISORDERS

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EXCESSIVE USE OF ALCOHOL AND/OR RECREATIONAL DRUGS

SLEEP APNEA

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UNHEALTHY DIET

Non-modifiable risk factors include:

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PRIOR STROKE, TIA OR HEART ATTACK

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INCREASING AGE

GENDER

FAMILY HISTORY

RACE/ETHNICITY

SIGNS AND SYMPTOMS

The signs of a recurrent stroke may resemble those of the first, but they can also present differently. Recognizing these symptoms and acting quickly is essential to minimizing damage and improving recovery. While there is no need to live in fear, staying vigilant and prepared is key.

Educate your family and caregivers about the following warning signs and ensure a clear plan is in place to respond promptly. If you live alone, make sure you can call the local emergency services on your own. Alternatively, coordinate with a trusted neighbor who can assist in case of an emergency. Remember, don’t delay and never attempt to drive yourself to the hospital.

Here are the most common warning signs to watch for:

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Sudden NUMBNESS or WEAKNESS

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Sudden CONFUSION

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Sudden VISION PROBLEMS

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Sudden DIFFICULTY WALKING

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Sudden SEVERE HEADACHE

HOW IS RECURRENT STROKE DIAGNOSED?

The diagnosis of a recurrent stroke is generally similar to that of a first stroke, but additional tests may be involved to investigate underlying causes more thoroughly and assess new risk factors that might have developed since the initial event. Here’s an overview:

Physical and neurological exam – if the recurrent stroke affects cognitive function more significantly than the first, additional assessments may be performed.
Blood tests – to evaluate new risk factors, such as inflammatory markers or genetic clotting disorders, especially if the cause of the previous stroke was unclear.
Imaging tests – these tests are crucial for identifying the type of stroke and guiding treatment:

- Computerized tomography (CT) scan: Quickly identifies bleeding in the brain or areas of brain damage from an ischemic stroke.
- Magnetic resonance imaging (MRI): Offers detailed images of the brain to detect any affected areas, even small changes, after an ischemic or hemorrhagic stroke.
Advanced tests:
- Electrocardiogram (EKG or ECG): identifies abnormal heart rhythms, such as atrial fibrillation.
- Carotid ultrasound: examines carotid arteries for blockages.
- Cerebral angiography: provides detailed imaging of the arteries in the brain and neck. A catheter is inserted through a small incision, typically in the groin, and guided to the carotid or vertebral artery. Dye is injected to make the arteries visible on X-ray images.
- Echocardiogram: uses sound waves to create detailed heart images. This procedure helps detect blood clots in the heart that may have travelled to the brain and caused a stroke.
- Long-term heart monitoring: devices like Holter monitors or implantable loop recorders may be used to detect irregular heart rhythms such as AFib that were not identified before a stroke happened.

TREATING AND MANAGING A RECURRENT STROKE

Recurrent ischemic stroke

Preventing recurrent ischemic strokes involves a comprehensive approach that includes lifestyle modifications, medication management and, in certain cases, surgical interventions. By addressing the root causes and managing your health proactively, you can significantly reduce the risk of another stroke.

They play a key role in reducing stroke recurrence:

Antithrombotic treatment which includes antiplatelet therapy (these drugs help prevent blood clots from forming) or anticoagulation therapy (for those with atrial fibrillation, anticoagulants, often referred to as a “blood thinner”, are used to reduce the risk of clot-related strokes).
Manage chronic conditions: For those living with hypertension, high cholesterol and/ or type 2 diabetes, medications are recommended to effectively control blood pressure, cholesterol and/ or blood sugar levels.

Making healthy lifestyle choices is the foundation of stroke prevention:

Adopt a balanced diet: Focus on fruits, vegetables, whole grains and lean proteins.
Stay active: Engage in regular physical activity as recommended by your healthcare provider.
Quit smoking: Smoking greatly increases stroke risk and quitting is one of the most impactful changes you can make. Also reduce your exposure to secondhand smoke.
Limit (or avoid) alcohol: Follow your doctor’s guidance on whether to limit or avoid alcohol.

In certain cases, procedures may be necessary to prevent a recurrent stroke:

Carotid endarterectomy or stenting: These procedures address significant arterial blockages that increase stroke risk.

Haemorrhagic Recurrent Stroke

Preventing recurrent hemorrhagic strokes focuses on addressing the underlying causes of bleeding and maintaining overall vascular health. This involves a combination of lifestyle adjustments, medication management and, in some cases, surgical interventions.

Proper medication management is essential in reducing the risk of recurrent hemorrhagic strokes:

Antihypertensive medications are crucial for managing high blood pressure, the leading cause of haemorrhagic strokes.
Careful use of anticoagulants and antiplatelets: In certain cases, avoiding these medications may be necessary to reduce the risk of further bleeding.

As with ischemic strokes, adopting a healthy lifestyle is essential for stroke prevention. Making changes such as following a balanced diet, staying physically active (as per your healthcare provider’s recommendation), quitting smoking, and limiting (or avoiding) alcohol intake can have a significant impact on reducing your risk.

In specific cases, medical or surgical interventions may be required to address the root causes:

Surgical interventions: Procedures like aneurysm clipping or the removal of arteriovenous malformations (AVMs) can help prevent future bleeding events.
Endovascular treatments: Minimally invasive procedures, such as coiling, can be used to treat aneurysms and prevent rupture

LIFESTYLE CHANGES TO PREVENT A RECURRENT STROKE

Making lifestyle changes is one of the most effective ways to reduce your risk of another stroke. By addressing key health factors and adopting healthy habits, you can take control of your recovery and long-term well-being.

Work with your healthcare team to understand what caused your strokes and address those specific risk factors.

Keep your blood pressure under control through regular monitoring, diet and medication.

Follow your doctor’s advice to manage cholesterol, including eating heart-healthy foods and taking prescribed medications.

If you have diabetes, maintain healthy blood sugar levels through proper diet, exercise and medication.

Regular physical activity, as approved by your doctor, improves circulation, strengthens your heart and helps manage weight.

Make the recommended dietary changes, such as reducing salt intake, managing liquids and eliminating foods that may counteract your medications. Your diet plays a crucial role in supporting your overall health.

If you smoke, stop immediately. Smoking significantly increases your risk of stroke recurrence.

Achieve and maintain a healthy weight to lower your risk of stroke and other health complications.

Follow your treatment plan exactly as you were told. Adherence to prescribed treatments, including blood pressure or cholesterol medications, is critical for prevention. If you have any uncertainties, don’t hesitate to reach out to your doctor.

Maintain connections with supportive individuals in your life and seek out peers who share similar experiences. Building an emotional support network is crucial for staying motivated and focused on your health goals. Share your journey, seek advice, and offer support to others in your community.

QUESTIONS TO ASK YOUR DOCTOR

Engaging in open and meaningful discussions with your healthcare provider is essential in managing your risk of recurrent strokes. Here are some questions to guide your conversations and help you take an active role in your health:

Understanding the cause: What caused my strokes?
Assessing my risk: What is my risk of having a recurrent stroke?
Understanding TIAs: I’ve experienced TIAs but not a stroke—should I still be concerned about the risk of having a major stroke?
Identifying warning signs: What symptoms should I watch for, and when should I seek emergency care?
Exploring prevention options: What steps can I take to reduce my risk of another stroke?
Discussing medications: What medications do I need to take, and what are their benefits and potential side effects?
Adopting lifestyle changes: What diet, exercise or lifestyle changes would you recommend for me?
Planning follow-ups: How often should I see you for follow-up care?
Finding trustworthy resources: Where can I access reliable information on preventing recurrent strokes?
Connecting with support networks: Are there support groups or programs for stroke survivors that you recommend?

TAKE CONTROL OF YOUR HEALTH AND REDUCE YOUR RISK OF ANOTHER STROKE.

Learn More: Explore Mended Hearts Europe’s educational resources.
Act Now: Schedule a health check-up to discuss risk management with your doctor.
Stay Connected: Join our community for ongoing support and guidance.

By staying informed and proactive, stroke survivors can significantly reduce their risk of recurrence and lead healthier, more fulfilling lives.

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