Take Steps to Prevent a Second Stroke, or a First Stroke After a TIA
This year, an estimated 800,000 people in the United States will suffer a stroke—some for the second or third time. Although 10 to 20 percent of strokes are fatal, seven million people in the United States are living proof that many survive the event. But these people are at greatly increased risk of having another stroke.
In May 2014, the American Heart Association and American Stroke Association (AHA/ASA) issued updated guidelines for preventing a second stroke, as well as for preventing a first stroke after a transient ischemic attack (TIA). In a TIA, the symptoms of stroke pass, usually in five to 20 minutes. However, the risk of having a full-blown stroke is very high following a TIA.
“Stroke and TIA are both neurological emergencies and should be urgently evaluated,” says Weill Cornell neurologist Louise Klebanoff, MD. “While a TIA may not leave permanent neurological damage or be seen on an MRI, the risk factors for TIA and stroke are the same, the evaluation is the same, and the treatment recommendations are the same,” she says.
WHAT IS A TIA?
A transient ischemic attack (TIA) is actually a stroke that resolves by itself, generally within five to 20 minutes. Like a full-blown stroke, it occurs when blood flow to the brain is halted by a blood clot, causing the symptoms of stroke. The body quickly attacks the clot and successfully breaks it up. As soon as blood flow resumes, the symptoms disappear. Because the difference between a TIA and a stroke cannot be immediately distinguished, anyone experiencing symptoms of stroke should call 911.
Symptoms of stroke and TIA include sudden onset of any of the following:
▶ Weakness or numbness of the face, arm, or leg, especially on one side of the body
▶ Trouble speaking or understanding speech; confusion
▶ Severe headache
▶ Disturbed vision (blurred vision, double vision, vision loss in one or both eyes)
▶ Difficulty walking, dizziness, or loss of balance
Minimizing risk factors
In June 2014, the American Academy of Neurology approved the new AHA/ASA guidelines, which were based on the most current evidence for secondary stroke prevention. Here’s what the experts recommend:
✓ Keep blood pressure below 140/90, starting several days after the stroke or TIA.
✓ Lower and keep LDL cholesterol below 100 mg/dL with statin drugs.
✓ Limit daily sodium consumption to 2.4 grams (2,400 milligrams) per day (about 1 tea-spoon); lowering sodium to less than 1.5 grams (1,500 milligrams) per day is preferred.
✓ Eat a Mediterranean-style diet, which emphasizes vegetables, fruits, whole grains, low-fat dairy products, poultry, fish, legumes, olive oil and nuts, and limits red meat, processed foods, and sweets.
✓ Screen patients who have had a stroke or TIA for diabetes, obesity, inactivity, sleep apnea, and inadequate nutrition, and take appropriate steps to minimize these risk factors.
Medical and surgical treatments
Sometimes, making lifestyle changes is not enough; medication, surgery, or an interventional procedure may be needed to prevent a stroke. The appropriate treatment for you will depend on many factors, including the potential source of the stroke and your age.
When a narrowed carotid artery in the neck threatens to cut off blood flow to the brain, one of two procedures can be used to widen the artery: a minimally invasive, catheter-based procedure called stenting, or surgery to open the artery and remove the obstructing plaque (endarterectomy). Either procedure is acceptable in patients who are at average or low risk for complications from surgery, though experience suggests that, in patients older than age 70, endarterectomy may provide the better outcome.
Blockages in the arteries of the brain itself pose a greater treatment challenge, as these locations are often inaccessible. When symptoms are caused by a major intracranial vessel that is 70 to 90 percent blocked, adding clopidogrel (Plavix) to aspirin for 90 days may reduce the likelihood of a stroke-causing blood clot.
Stroke and your heart
An irregular heart rhythm condition called atrial fibrillation (Afib) is a significant risk factor for stroke. When the underlying cause of stroke is unknown, 30-day cardiac rhythm monitoring is rec-ommended. When Afib is confirmed, warfarin (Coumadin) or a newer anticoagulant should be used for stroke prevention. If Afib is caused by heart valve disease, warfarin, an older drug, is the treatment of choice.
Follow your doctor’s instructions
Your doctor will use the information he or she compiles to create an individualized plan to re-duce your risk of stroke, but it’s up to you to carry it out. Although following through on medi-cal advice sounds logical, studies show that a shocking percentage of patients don’t follow their doctor’s advice. In one study, 23 percent did not take aspirin as recommended, 34 percent continued to smoke, and nine percent refused to take medicine to lower their blood pres-sure.
“The latest guidelines are only effective if they are followed. If you have experienced a stroke or TIA, you should do everything you can to prevent another stroke, or, in the case of TIA, a first stroke, from happening,” says Dr. Klebanoff.
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