Risk Stratification tools for Transient Ischemic Attack: Which patients require hospital admission?

Cervical and intracranial arterial evaluation is an important issue for acute ischemic stroke (IS). Objective Compare the use of the neurovascular ultrasound examination (NVUE) to digital subtraction angiography (DSA) in acute IS patients for diagnosing significant extracranial and intracranial arteriopathy. Method Nonconsecutive patients with IS or transient ischemic attack admitted within 12 hours of the onset of symptoms were evaluated retrospectively. Standardized NVUE and DSA were done in all patients within the first 120 hours of hospital admission. Results Twenty-four patients were included in the study. Compared to DSA, the NVUE demonstrated 94.7% sensitivity and 100% specificity for identifying symptomatic extracranial and/or intracranial arteriopathy. Conclusion The standardized NVUE technique demonstrated high sensitivity and specificity compared to DSA for diagnosing arterial abnormalities in acute IS patients.

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Stroke Epidemiology, Patterns of Management, and Outcomes in Fortaleza, Brazil

Stroke ◽

10.1161/strokeaha.111.626523 ◽

2011 ◽

Vol 42 (12) ◽

pp. 3341-3346 ◽

Cited By ~ 58

Author(s):

João José Freitas de Carvalho ◽

Monique Bueno Alves ◽

Georgiana Álvares Andrade Viana ◽

Cícera Borges Machado ◽

Bento Fortunato Cardoso dos Santos ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Hospital Mortality ◽

Hospital Admission ◽

Median Time ◽

Transient Ischemic Attack ◽

Stroke Risk Factors ◽

Level Of Consciousness ◽

Ischemic Attack ◽

Stroke Epidemiology

Background and Purpose— Little information exists on the epidemiology and patterns of treatment of patients admitted to Brazilian hospitals with stroke. Our objective was to describe the frequency of risk factors, patterns of management, and outcome of patients admitted with stroke in Fortaleza, the fifth largest city in Brazil. Methods— Data were prospectively collected from consecutive patients admitted to 19 hospitals in Fortaleza with a diagnosis of stroke or transient ischemic attack from June 2009 to October 2010. Results— We evaluated 2407 consecutive patients (mean age, 67.7±14.4 years; 51.8% females). Ischemic stroke was the most frequent subtype (72.9%) followed by intraparenchymal hemorrhage (15.2%), subarachnoid hemorrhage (6.0%), transient ischemic attack (3%), and undetermined stroke (2.9%). The median time from symptoms onset to hospital admission was 12.9 (3.8–32.5) hours. Hypertension was the most common risk factor. Only 1.1% of the patients with ischemic stroke received thrombolysis. The median time from hospital admission to neuroimaging was 3.4 (1.2–26.5) hours. In-hospital mortality was 20.9% and the frequency of modified Rankin Scale score ≤2 at discharge was less than 30%. Older age, prestroke disability, and having a depressed level of consciousness at admission were independent predictors of poor outcome; conversely, male gender was a predictor of good outcome. Conclusions— The prevalence of stroke risk factors and clinical presentation in our cohort were similar to previous series. Treatment with thrombolysis and functional independency after a stroke admission were infrequent. We also found long delays in hospital admission and in evaluation with neuroimaging and high in-hospital mortality.

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Copeptin and Risk Stratification in Patients with Ischemic Stroke and Transient Ischemic Attack: The CoRisk Study

International Journal of Stroke ◽

10.1111/j.1747-4949.2011.00762.x ◽

2012 ◽

Vol 8 (3) ◽

pp. 214-218 ◽

Cited By ~ 17

Author(s):

Gian Marco De Marchis ◽

Mira Katan ◽

Anja Weck ◽

Caspar Brekenfeld ◽

Heinrich P Mattle ◽

...

Keyword(s):

Ischemic Stroke ◽

Risk Stratification ◽

Transient Ischemic Attack ◽

Ischemic Attack

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Deintensification or No Statin Treatment Is Associated With Higher Mortality in Patients With Ischemic Stroke or Transient Ischemic Attack

Stroke ◽

10.1161/strokeaha.120.030089 ◽

2021 ◽

Author(s):

Jennifer L. Dearborn-Tomazos ◽

Xin Hu ◽

Dawn M. Bravata ◽

Manali A. Phadke ◽

Fitsum M. Baye ◽

...

Keyword(s):

Ischemic Stroke ◽

Hospital Admission ◽

Hospital Discharge ◽

Transient Ischemic Attack ◽

Statin Treatment ◽

Veterans Health ◽

Health Administration ◽

High Potency ◽

Ischemic Attack ◽

Statin Dose

Background and Purpose: Practice guidelines recommend that most patients receive moderate- or high-potency statins after ischemic stroke or transient ischemic attack (TIA) of atherosclerotic origin. We tested the association of different patterns of potency for prescribed statin therapy—assessed before admission and at hospital discharge for ischemic stroke or TIA—on mortality in a large, nationwide sample of US Veterans. Methods: The study population included patients with an ischemic stroke or TIA occurring during 2011 at any of the 134 Veterans Health Administration facilities. We used electronic outpatient pharmacy files to identify statin dose at hospital admission and within 7 days after hospital discharge. We categorized statin dosing as low, moderate, or high potency; moderate or high potency was considered at goal. We created 6 mutually exclusive groups to reflect patterns of statin potency from hospital admission to discharge: goal to goal, low to goal, goal to low or goal to none (deintensification), none to none, none to low, and low to low. We used logistic regression to compare 30-day and 1-year mortality across statin potency groups. Results: The population included 9380 predominately White (71.1%) men (96.3%) who were hospitalized for stroke or TIA. In this sample, 34.1% of patients (n=3194) were discharged off a statin medication. Deintensification occurred in 14.0% of patients (n=1312) and none to none in 20.5% (n=1924). Deintensification and none to none were associated with a higher odds of mortality as compared with goal to goal (adjusted odds ratio 1-year mortality: deintensification versus goal to goal, 1.26 [95% CI, 1.02–1.57]; none to none versus goal to goal, 1.59 [95% CI, 1.30–1.93]). Adjustments for differences in baseline characteristics using propensity weighted scores demonstrated similar results. Conclusions: Underutilization of statins, including no treatment or underdosing after stroke (deintensification), was observed in approximately one-third of veterans with ischemic stroke or TIA and was associated with higher mortality when compared with patients who were at goal for statin prescription dosing.

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