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Background <p>Recurrent strokes account for up to 1 out of 4 strokes in Low-and-Middle-Income-Countries (LMICs), culminating in worsening of outcomes. International guidelines recommend subtype-specific etiological workup to help tailor strategies for prevention of recurrence after an index stroke. However, huge gaps in secondary stroke prevention persist in LMICs.</p> Objectives <p>We aimed to assess the extent of diagnostic evaluation (for risk-factor and underlying etiological identification) and treatment approaches among recurrent stroke patients in a Ghanaian tertiary hospital.</p> Methods <p>This was a cross-sectional study among recurrent stroke cases admitted to Komfo Anokye Teaching Hospital between 2023 and 2025. The data was analyzed using SPSS Version 28.</p> Results <p>Recurrent strokes accounted for 17.8% of all stroke admissions over 2 years, with ischemic strokes comprising 76.2% of these recurrent events. Hypertension was the most dominant modifiable risk factor among both ischemic and hemorrhagic subtypes, 97.0% and 92.1% respectively, (<i>p</i> = 0.297). Only a minority of ischemic stroke patients (12.6%) had sufficient diagnostic evaluation to allow definitive etiological classification according to the TOAST framework. Only 7.9% of hemorrhagic strokes underwent Computed tomography angiography (CTA)/ Magnetic resonance angiography (MRA) to evaluate for structural causes. Most ischemic stroke patients were prescribed a statin (93.7%) and an antiplatelet, while anticoagulant therapy was used only in a minority of patients (3.91%). Carotid endarterectomy or carotid stenting was not performed for any of the ischemic stroke patients.</p> Conclusion <p>Our findings highlight significant gaps in recurrent stroke evaluation and management in the Ghanaian setting. Standardized algorithms for secondary stroke prevention and treatment are urgently needed to mitigate recurrence.</p>

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Diagnostic and therapeutic gaps in recurrent stroke management: real-world insights from a Ghanaian hospital-based registry

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月30日

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  • Priscilla Abrafi Opare-Addo,
  • Fred Stephen Sarfo,
  • Minas Aikins,
  • Enock Asante,
  • Maxwell Nyanaah,
  • Nana Osei Asibey Derkyi,
  • Jessey Mahama Holu,
  • Gordon Manu Amponsah

摘要

Background

Recurrent strokes account for up to 1 out of 4 strokes in Low-and-Middle-Income-Countries (LMICs), culminating in worsening of outcomes. International guidelines recommend subtype-specific etiological workup to help tailor strategies for prevention of recurrence after an index stroke. However, huge gaps in secondary stroke prevention persist in LMICs.

Objectives

We aimed to assess the extent of diagnostic evaluation (for risk-factor and underlying etiological identification) and treatment approaches among recurrent stroke patients in a Ghanaian tertiary hospital.

Methods

This was a cross-sectional study among recurrent stroke cases admitted to Komfo Anokye Teaching Hospital between 2023 and 2025. The data was analyzed using SPSS Version 28.

Results

Recurrent strokes accounted for 17.8% of all stroke admissions over 2 years, with ischemic strokes comprising 76.2% of these recurrent events. Hypertension was the most dominant modifiable risk factor among both ischemic and hemorrhagic subtypes, 97.0% and 92.1% respectively, (p = 0.297). Only a minority of ischemic stroke patients (12.6%) had sufficient diagnostic evaluation to allow definitive etiological classification according to the TOAST framework. Only 7.9% of hemorrhagic strokes underwent Computed tomography angiography (CTA)/ Magnetic resonance angiography (MRA) to evaluate for structural causes. Most ischemic stroke patients were prescribed a statin (93.7%) and an antiplatelet, while anticoagulant therapy was used only in a minority of patients (3.91%). Carotid endarterectomy or carotid stenting was not performed for any of the ischemic stroke patients.

Conclusion

Our findings highlight significant gaps in recurrent stroke evaluation and management in the Ghanaian setting. Standardized algorithms for secondary stroke prevention and treatment are urgently needed to mitigate recurrence.