Update of secondary stroke prevention

Secondary prevention aims at preventing a stroke after a transient ischaemic attack (TIA) or a recurrent stroke after a first stroke. About 80–85% of patients survive a first ischaemic stroke [1,2]. Of those, between 8 and 15% suffer a recurrent stroke in the first year. The risk of stroke recurrence is highest in the first few weeks and declines over time [3–5]. The risk of recurrence depends on concomitant vascular diseases (coronary heart disease = CHD, peripheral arterial disease = PAD) and vascular risk factors and can be estimated by risk models [6–8]. Stroke risk after a TIA is highest in the first 3 days [9]. Therefore, immediate evaluation of patients with a stroke or TIA, identification of the pathophysiology and initiation of secondary prevention are of major importance [10]. In the following sections, we will deal with the treatment of risk factors, antithrombotic therapy and surgery or stenting of significant stenosis of extracranial arteries.