By definition,<unk> s are<unk> , self-resolving, and do not cause permanent impairment. However, they are associated with an increased risk of subsequent<unk>  strokes, which can be permanently disabling. Therefore, management centers on the prevention of future<unk>  strokes and addressing any modifiable risk factors. The optimal regimen depends on the underlying cause of the<unk> . Lifestyle modification Lifestyle changes have not been shown to reduce the risk of stroke after<unk> . While no studies have looked at the optimal diet for secondary prevention of stroke, some observational studies have shown that a Mediterranean diet can reduce stroke risk in patients without cerebrovascular disease. A Mediterranean diet is rich in fruits, vegetables and whole grains, and limited in red meats and sweets. Vitamin supplementation has not been found to be useful in secondary stroke prevention. Antiplatelet medications The antiplatelet medications, aspirin and clopidogrel, are both recommended for secondary prevention of stroke after high-risk<unk> s. The clopidogrel can generally be stopped after 10 to 21 days. An exception is<unk> s due to blood clots originating from the heart, in which case anticoagulants are generally recommended. After<unk>  or minor stroke, aspirin therapy has been shown to reduce the short-term risk of recurrent stroke by 60–70%, and the long-term risk of stroke by 13%. The typical therapy may include aspirin alone, a combination of aspirin plus extended-release dipyridamole, or clopidogrel alone. Clopidogrel and aspirin have similar efficacies and side effect profiles. Clopidogrel is more expensive and has a slightly decreased risk of GI bleed. Another antiplatelet, ticlopidine, is rarely used due to increased side effects. Anticoagulant medications Anticoagulants may be started if the<unk>  is thought to be attributable to atrial fibrillation. Atrial fibrillation is an abnormal heart rhythm that may cause the formation of blood clots that can travel to the brain, resulting in<unk> s or<unk>  strokes. Atrial fibrillation increases stroke risk by five times, and is thought to cause 10-12% of all<unk>  strokes in the US. Anticoagulant therapy can decrease the relative risk of<unk>  stroke in those with atrial fibrillation by 67% Warfarin is a common anticoagulant used, but direct acting oral anticoagulants (DOACs), such as apixaban, have been shown to be equally effective while also conferring a lower risk of bleeding. Generally, anticoagulants and antiplatelets are not used in combination, as they result in increased bleeding risk without a decrease in stroke risk. However, combined antiplatelet and anticoagulant therapy may be warranted if the patient has symptomatic coronary artery disease in addition to atrial fibrillation. Sometimes, myocardial infarction ("heart<unk> ") may lead to the formation of a blood clot in one of the chambers of the heart. If this is thought to be the cause of the<unk> , people may be temporarily treated with warfarin or other anticoagulant to decrease the risk of future stroke. Blood pressure control Blood pressure control may be indicated after<unk>  to reduce the risk of<unk>  stroke. About 70% of patients with recent<unk>  stroke are found to have hypertension, defined as systolic blood pressure (SBP) > 140 mmHg, or diastolic blood pressure (DBP) > 90 mmHg. Until the first half of the 2010s, blood pressure goals have generally been SBP < 140 mmHg and DBP < 90 mmHg. However, newer studies suggest that a goal of SBP <130 mmHg may confer even greater benefit. Blood pressure control is often achieved using diuretics or a combination of diuretics and angiotensin converter enzyme inhibitors, although the optimal treatment regimen depends on the individual. Studies that evaluated the application of Blood pressure‐lowering drugs in people who suffered a<unk>  or stroke, concluded that this type of medication helps to reduce the possibility of a recurrent stroke, of a major vascular event and dementia. The effects achieved in stroke recurrence were mainly obtained through the ingestion of angiotensin-converting enzyme (ACE) inhibitor or a diuretic. Cholesterol control There is inconsistent evidence regarding the effect of LDL-cholesterol levels on stroke risk after<unk> . Elevated cholesterol may increase<unk>  stroke risk while decreasing the risk of hemorrhagic stroke. While its role in stroke prevention is currently unclear, statin therapy has been shown to reduce all-cause mortality and may be recommended after<unk> . Diabetes control Diabetes mellitus increases the risk of<unk>  stroke by 1.5-3.7 times, and may account for at least 8% of first<unk>  strokes. While intensive glucose control can prevent certain complications of diabetes such as kidney damage and retinal damage, there has previously been little evidence that it decreases the risk of stroke or death. However, data from 2017 suggests that metformin, pioglitazone and semaglutide may reduce stroke risk. Surgery If the<unk>  affects an area that is supplied by the carotid arteries, a carotid ultrasound scan may demonstrate stenosis, or narrowing, of the carotid artery. For people with extra-cranial carotid stenosis, if 70-99% of the carotid artery is clogged, carotid endarterectomy can decrease the five-year risk of<unk>  stroke by approximately half. For those with extra-cranial stenosis between 50-69%, carotid endarterectomy decreases the 5-year risk of<unk>  stroke by about 16%. For those with extra-cranial stenosis less than 50%, carotid endarterectomy does not reduce stroke risk and may, in some cases, increase it. The effectiveness of carotid endarterectomy or carotid artery stenting in reducing stroke risk in people with intra-cranial carotid artery stenosis is currently unknown. In carotid endarterectomy, a surgeon makes an incision in the neck, opens up the carotid artery, and removes the plaque occluding the blood vessel. The artery may then be repaired by adding a graft from another vessel in the body, or a woven patch. In patients who undergo carotid endarterectomy after a<unk>  or minor stroke, the 30-day risk of death or stroke is 7%. Carotid artery stenting is a less invasive alternative to carotid endarterectomy for people with extra-cranial carotid artery stenosis. In this procedure, the surgeon makes a small cut in the groin and threads a small flexible tube, called a catheter, into the patient's carotid artery. A balloon is inflated at the site of stenosis, opening up the clogged artery to allow for increased blood flow to the brain. To keep the vessel open, a small wire mesh coil, called a stent, may be inflated along with the balloon. The stent remains in place, and the balloon is removed. For people with symptomatic carotid stenosis, carotid endarterectomy is associated with fewer perioperative deaths or strokes than carotid artery stenting. Following the procedure, there is no difference in effectiveness if you compare carotid endarterectomy and carotid stenting procedures, however, endarterectomy is often the procedure of choice as it is a safer procedure and is often effective in the longer term for preventing recurrent stroke. For people with asymptomatic carotid stenosis, the increased risk of stroke or death during the stenting procedure compared to an endarterectomy is less certain. People who undergo carotid endarterectomy or carotid artery stenting for stroke prevention are medically managed with antiplatelets, statins, and other interventions as well.
Transient ischemic attack
Seizure
Subarachnoid hemorrhage
Epidural hematoma
Hemiplegic migraine
Ménière's disease  Ménière's disease  1
Watershed stroke
Migraine