ASC Stroke Prevention & Risk Management 2 — Questions and Answers
Question 1: A 68-year-old patient with a recent TIA has a CHADS2 score of 3. Which anticoagulation strategy is most appropriate?
- Aspirin 81mg daily
- Clopidogrel plus aspirin dual antiplatelet therapy
- Anticoagulation with a direct oral anticoagulant or warfarin (Correct answer)
- No antithrombotic therapy needed after TIA
Correct answer: Anticoagulation with a direct oral anticoagulant or warfarin
A CHADS2 score of 3 indicates high stroke risk in atrial fibrillation, making anticoagulation the preferred stroke prevention strategy.
Question 2: Which lipid-lowering target is recommended for patients with ischemic stroke or TIA of atherosclerotic origin to reduce recurrent stroke risk?
- LDL <100 mg/dL
- LDL <70 mg/dL (Correct answer)
- LDL <130 mg/dL
- Total cholesterol <200 mg/dL
Correct answer: LDL <70 mg/dL
High-intensity statin therapy targeting LDL <70 mg/dL is recommended for atherosclerotic ischemic stroke or TIA to reduce recurrence.
Question 3: A patient with symptomatic ipsilateral carotid stenosis of 75% is medically stable. What is the recommended timeframe for carotid revascularization?
- Within 2 weeks of the index event (Correct answer)
- Within 3 months of the index event
- After 6 months of medical optimization
- Revascularization is not indicated above 70%
Correct answer: Within 2 weeks of the index event
Early carotid revascularization within 2 weeks of a TIA or minor stroke provides the greatest reduction in recurrent stroke risk for high-grade symptomatic stenosis.
Question 4: Which blood pressure target is recommended for long-term secondary stroke prevention in a non-lacunar ischemic stroke patient?
- <150/90 mmHg
- <140/90 mmHg or lower (Correct answer)
- <160/100 mmHg
- <130/80 mmHg only if diabetic
Correct answer: <140/90 mmHg or lower
Guidelines recommend achieving BP <140/90 mmHg (and ideally lower) for most ischemic stroke survivors to reduce recurrent event risk.
Question 5: Patent foramen ovale (PFO) closure is most appropriate in which stroke patient population?
- All ischemic stroke patients regardless of age
- Patients over 65 with large PFO and atrial septal aneurysm
- Younger patients (<60) with cryptogenic stroke and high-risk PFO features (Correct answer)
- Any patient with PFO found incidentally on echocardiography
Correct answer: Younger patients (<60) with cryptogenic stroke and high-risk PFO features
PFO closure is recommended for younger cryptogenic stroke patients with high-risk anatomic features (large shunt, atrial septal aneurysm) after ruling out other etiologies.
Question 6: A diabetic patient post-stroke has an HbA1c of 9.2%. What is the primary glycemic management goal for stroke prevention?
- Rapid reduction of HbA1c to <6% within 3 months
- Moderate glycemic control targeting HbA1c <7–8% while avoiding hypoglycemia (Correct answer)
- Insulin therapy only, regardless of baseline HbA1c
- Glycemic control has no evidence for stroke risk reduction
Correct answer: Moderate glycemic control targeting HbA1c <7–8% while avoiding hypoglycemia
Moderate glycemic control (HbA1c <7–8%) is recommended for diabetic stroke survivors, balancing cardiovascular benefit against hypoglycemia risk.
Question 7: Which non-pharmacologic intervention has the strongest evidence for primary stroke prevention in adults with hypertension?
- Vitamin E supplementation
- Salt restriction combined with the DASH diet (Correct answer)
- Omega-3 fatty acid supplements
- Routine aspirin use in all hypertensive adults
Correct answer: Salt restriction combined with the DASH diet
The DASH diet combined with sodium restriction consistently lowers blood pressure and is among the most evidence-based lifestyle interventions for primary stroke prevention.
ASC Stroke Prevention & Risk Management 2
A 68-year-old patient with a recent TIA has a CHADS2 score of 3.
Which anticoagulation strategy is most appropriate?