Stroke Trends and Risk Factors

In this episode, Ashkan Shoamanesh, MD, FRCPC, FESO discussed the following questions with Greg Albers, MD and other panelists:

1. Can you discuss timing of stroke recurrence?
2. In which ischemic stroke subtypes are there existing unmet needs for stroke prevention?

The discussion highlights that stroke recurrence risk is both an acute and long‑term issue: it is “front loaded,” with the highest danger in the first days to weeks after a TIA or minor stroke, followed by a 5–10% risk of recurrence over the first year and up to 30% over 5–10 years. This risk varies across patients based on stroke subtype and individual vascular risk factors, as well as how well those modifiable factors (e.g., blood pressure, diabetes, lipids, smoking) are controlled. In today’s era of personalized medicine, clinicians classify strokes by mechanism (e.g., cardioembolic, large‑artery atherosclerosis, ESUS, lacunar) and tailor prevention accordingly, but there are important disparities in access to care and major gaps in evidence, especially for underrepresented groups. Dual antiplatelet therapy is started as early as possible (ideally within 24–48 hours, and up to ~72 hours) in selected high‑risk non‑cardioembolic patients, typically continued for about 21 days to balance ischemic benefit against bleeding risk, after which patients are usually de‑escalated to single antiplatelet therapy.

The next episode in this series, “Secondary Stroke Prevention Strategies at System Level,” features the panelists advancing their conversation on secondary stroke prevention.