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What can trigger a second stroke?

Having a stroke is a frightening experience. After surviving an initial stroke, many people worry about having another one. While some risk factors for stroke cannot be changed, there are steps stroke survivors can take to reduce their chances of recurrence.

What is a recurrent stroke?

A recurrent stroke, also called a repeat stroke or second stroke, is a stroke that occurs after a previous stroke or transient ischemic attack (TIA or mini-stroke). About 25% of strokes are recurrent strokes.

Types of recurrent strokes

There are two main types of recurrent strokes:

  • Early recurrent strokes – These happen within 30 days of an initial stroke.
  • Late recurrent strokes – These occur more than 30 days after an initial stroke.

What triggers a second stroke?

There are various risk factors that can increase a person’s chance of having a recurrent stroke, including:

Uncontrolled risk factors

  • High blood pressure – The most significant risk factor for stroke recurrence. Keeping blood pressure under control is key.
  • Diabetes – Having elevated blood sugar levels over time can damage blood vessels and make recurrent stroke more likely.
  • High cholesterol – High LDL cholesterol causes fatty deposits to build up in arteries.
  • Smoking – Smoking damages blood vessel walls and increases clotting risk.
  • Obesity – Being overweight strains the cardiovascular system.
  • Physical inactivity – Lack of exercise is associated with higher stroke risk.

Underlying conditions

  • AFib – Irregular heartbeat condition that can allow blood clots to form.
  • Heart disease – Conditions like coronary artery disease increase stroke risk.
  • Prior stroke – Having already had one stroke is a risk factor for having another.
  • TIA – Mini-strokes are an important stroke warning sign.
  • Carotid artery disease – Plaque buildup in the neck arteries that supply blood to the brain.

Medication issues

  • Not taking prescribed medications properly
  • Starting new medications that can increase stroke risk
  • Stopping medications that help prevent strokes

Reducing your risk of another stroke

Making lifestyle changes and following your doctor’s recommendations can help lower your chances of having a repeat stroke. Some tips include:

  • Take medications as directed to control conditions like high blood pressure, diabetes, and high cholesterol.
  • Eat a diet low in sodium, fat, and refined sugars.
  • Stay active with regular moderate exercise.
  • Aim for a healthy weight.
  • Manage stress.
  • Limit alcohol intake.
  • Quit smoking and avoid secondhand smoke.
  • Follow up regularly with your healthcare provider.

Treatment for carotid artery disease

If carotid artery disease is contributing to your stroke risk, your doctor may recommend:

  • Carotid endarterectomy – Surgical procedure to remove plaque blockages.
  • Carotid angioplasty and stenting – Using a catheter to open narrowed carotid arteries.

Warning signs of stroke

Being able to identify the signs of stroke is vital for getting prompt treatment. Call 911 immediately if you notice any of the following:

  • Numbness or weakness on one side of the body
  • Confusion
  • Trouble speaking or understanding speech
  • Vision problems
  • Dizziness or loss of balance/coordination
  • Severe headache

Getting medical attention as soon as possible can help minimize brain damage and disability from the stroke.


Recurrent strokes can be prevented through lifestyle changes and medical management of underlying risk factors. Controlling conditions like high blood pressure and diabetes, along with adopting healthy habits, can significantly lower your risk of having another stroke. Staying aware of stroke warning signs and acting quickly are also key to improving outcomes.