ASC Stroke Prevention & Risk Management 3 — Questions and Answers
Question 1: A patient with lacunar infarct and well-controlled hypertension is found to have no AF on 30-day cardiac monitoring. Which antithrombotic regimen is preferred for secondary prevention?
- Anticoagulation with warfarin (INR 2–3)
- Dual antiplatelet therapy indefinitely
- Single antiplatelet agent (aspirin or clopidogrel) (Correct answer)
- No antithrombotic therapy
Correct answer: Single antiplatelet agent (aspirin or clopidogrel)
Single antiplatelet therapy is preferred for lacunar stroke secondary prevention, as anticoagulation and long-term DAPT have not shown superior benefit and increase bleeding risk.
Question 2: Obstructive sleep apnea (OSA) is an independent risk factor for stroke. Which intervention is recommended to reduce stroke risk in patients with moderate-to-severe OSA?
- Benzodiazepine therapy to improve sleep quality
- Continuous positive airway pressure (CPAP) therapy (Correct answer)
- Weight loss surgery only
- Oxygen supplementation during sleep
Correct answer: Continuous positive airway pressure (CPAP) therapy
CPAP therapy is the recommended treatment for moderate-to-severe OSA and is associated with reduced cardiovascular and stroke risk.
Question 3: Which scoring tool is specifically designed to assess early stroke risk after a TIA to guide urgency of evaluation?
- NIHSS
- ABCD2 score (Correct answer)
- mRS
- Hunt and Hess scale
Correct answer: ABCD2 score
The ABCD2 score (Age, Blood pressure, Clinical features, Duration, Diabetes) stratifies early stroke risk following TIA to prioritize rapid evaluation.
Question 4: A 55-year-old patient with no prior cardiovascular disease is found to have a 10-year cardiovascular risk of 9%. Aspirin for primary prevention is:
- Recommended to reduce both MI and stroke risk
- Recommended only if the patient has diabetes
- Not recommended due to net harm from bleeding risk (Correct answer)
- Recommended at low dose every other day
Correct answer: Not recommended due to net harm from bleeding risk
Current guidelines recommend against routine aspirin for primary prevention in adults without established cardiovascular disease due to bleeding risk exceeding modest cardiovascular benefit.
Question 5: In patients with symptomatic intracranial atherosclerotic disease (ICAD) causing 70–99% stenosis, which combination is recommended for secondary prevention?
- Aspirin plus warfarin (INR 2–3)
- Aspirin plus clopidogrel for 90 days, then single antiplatelet (Correct answer)
- DOAC monotherapy
- Statin therapy alone without antithrombotics
Correct answer: Aspirin plus clopidogrel for 90 days, then single antiplatelet
The SAMMPRIS trial supports aspirin plus clopidogrel for 90 days followed by aspirin monotherapy combined with aggressive risk factor management for high-grade ICAD.
Question 6: A stroke coordinator is counseling a patient about modifiable stroke risk factors. Which factor contributes the MOST to global stroke burden?
- Atrial fibrillation
- Hypertension (Correct answer)
- Smoking
- Diabetes mellitus
Correct answer: Hypertension
Hypertension is the single largest modifiable risk factor for stroke globally, accounting for approximately 54% of stroke mortality.
Question 7: Which antihypertensive drug class has the strongest evidence specifically for reducing recurrent stroke risk when used in post-stroke patients?
- Beta-blockers
- ACE inhibitors with thiazide diuretics (Correct answer)
- Alpha-1 blockers
- Calcium channel blockers alone
Correct answer: ACE inhibitors with thiazide diuretics
The PROGRESS trial demonstrated that the combination of perindopril (ACE inhibitor) plus indapamide (thiazide-like diuretic) significantly reduced recurrent stroke risk.
ASC Stroke Prevention & Risk Management 3
A patient with lacunar infarct and well-controlled hypertension is found to have no AF on 30-day cardiac monitoring.
Which antithrombotic regimen is preferred for secondary prevention?