Secondary Prevention after Ischemic Stroke or Transient Ischemic Attack

Nejm.org: May 17, 2012.
This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations.

Stage

A 62-year-old woman is seen 1 week after an ischemic stroke. She had presented to another hospital with dysphasia and right-sided weakness; magnetic resonance imaging (MRI) showed a recent infarction in the left parietal cortex, and computed tomographic angiography (CTA) showed a high-grade stenosis in the left proximal internal carotid artery with normal intracranial vessels (Figure 1). She was treated with intravenous recombinant tissue plasminogen activator and discharged home, taking aspirin and a statin. She stopped smoking 12 years ago. On examination, the blood pressure is 145/90 mm Hg. She reports some mild residual clumsiness of her right hand. . . . Read more