The Evolving Landscape of Secondary Stroke Prevention

In the concluding episode of this NeurologyLive® Special Report, Mike Sharma, MD, explores how secondary stroke prevention has transformed from reactive management to proactive, rapid-response care. He describes the evolution of acute TIA evaluation—highlighting the critical 48-hour window for intervention—and how advances in vascular imaging and early carotid revascularization have reshaped outcomes.

Dr. Sharma also discusses how contemporary vascular risk reduction now includes aggressive management of hypertension, diabetes, dyslipidemia, smoking, and sleep apnea, paired with short-term dual antiplatelet therapy. Yet, he notes, aspirin remains the long-term standard—a benchmark largely unchanged for half a century. Looking ahead, he sees trials like OCEANIC-STROKE as pivotal in ushering in a new generation of precision antithrombotics that could finally offer stroke specialists the efficacy of anticoagulation with the safety of antiplatelet therapy, redefining how secondary prevention is approached across neurology practice.