Stroke is an acute cerebral blood circulation disorder caused by narrowing, occlusion or rupture of an artery in the brain due to various precipitating factors in patients with cerebrovascular disease, which is clinically manifested by signs and symptoms of one-time or permanent cerebral dysfunction. Stroke is divided into ischemic stroke and hemorrhagic stroke. Ischemic strokes account for about 80% of all strokes. It is a softening and necrosis of local brain tissue due to impaired blood circulation, ischemia and hypoxia. The prognosis after ischemic stroke varies, but studies show that about 30% of survivors do not achieve full recovery, although they do not need help with daily activities. Another 20% of survivors need to receive assistance with at least one activity. The life expectancy of stroke survivors decreases dramatically and the likelihood of recurrence of cerebrovascular events increases rapidly. Prevention of ischemic stroke is therefore particularly important. However, in China, most patients often go to the doctor only when they have symptoms, so secondary prevention, i.e., early diagnosis and treatment, has become the focus of ischemic stroke prevention in China. Aspirin is a basic drug for stroke prevention and treatment, and it is effective in preventing stroke recurrence. However, clinical application of aspirin shows that 47% of patients have resistance to the drug, and even aspirin enteric tablets can cause burden and impact on the stomach and intestines. Is there another option in case aspirin is not suitable for long-term use? The good news is that we have come to realize that aspirin is not the only option for preventing ischemic strokes. The key to secondary prevention of ischemic stroke lies in the diagnosis of the cause of stroke and the recognition of risk factors, and the development of targeted and individualized treatment plans for patients with different risk of recurrence, depending on the number and severity of risk factors. For example, high blood pressure can accelerate the development of atherosclerosis, and the higher the blood pressure, the greater the chance of cerebral infarction or recurrence of cerebral infarction; high blood lipid makes the blood sticky, slow blood flow, and reduces the amount of blood supply to the brain. This leads directly to the occurrence and development of cardiovascular and cerebrovascular diseases. Diabetes can lead to abnormal lipid metabolism, often accompanied by atherosclerosis, hyperlipidemia and cardiovascular disease, and the increased glucose content in the blood will also increase blood viscosity and coagulation, which is conducive to the formation of cerebral infarction. On the basis of strict control of blood glucose and blood pressure, combined with statins, active control of these risk factors can reduce the occurrence or recurrence of cerebrovascular disease. 2, some patients at high risk of cardiogenic embolism, such as those with a history of atrial fibrillation, acute myocardial infarction, valvular heart disease, warfarin may be more suitable than aspirin. For patients with atrial fibrillation who are unable or unwilling to receive the oral anticoagulant warfarin, clopidogrel combined with aspirin therapy can also yield better results compared to the aspirin alone group. 3, of course, for some patients with large atherosclerotic stroke drug therapy is not the only method, domestic and foreign studies have shown that for patients with symptomatic carotid stenosis 70% to 99%, the benefit is greater than the risk of surgery, the implementation of carotid endarterectomy is recommended. With the rapid development of interventional techniques in recent years endovascular treatment of intracranial and extracranial artery stenosis has also become one of the treatment options for carotid atherosclerotic stenosis. The prevention of ischemic stroke should be based on a combination of diet, exercise, medication, and risk factor control, especially for patients who have had an ischemic stroke. Aspirin is not the only option for secondary prevention of ischemic stroke, and a single aspirin treatment cannot be adapted to the needs of different patients. A clear diagnosis of the cause of stroke and an improved understanding of risk factors will allow more patients to benefit from an individualized treatment plan and achieve better results.