Prevalence of Positive Diffusion-Weighted Imaging Findings and Ischemic Stroke Recurrence in Transient Ischemic Attack

Ischemic stroke and transient ischemic attack (TIA) are the most common cerebrovascular disorder and leading cause of death in China. The Effective secondary prevention is the vital strategy for reducing stroke recurrence. The aim of this guideline is to provide the most updated evidence-based recommendation to clinical physicians from the prior version. Control of risk factors, intervention for vascular stenosis/occlusion, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke are all recommended, and the prevention of recurrent stroke in a variety of uncommon causes and subtype provided as well. We modified the level of evidence and recommendation according to part of results from domestic RCT in order to facility the clinical practice.

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Clinical Effects of Dual Antiplatelet Therapy or Aspirin Monotherapy after Acute Minor Ischemic Stroke or Transient Ischemic Attack, a Meta-Analysis

Current Pharmaceutical Design ◽

10.2174/1381612827666210728102459 ◽

2021 ◽

Vol 27 ◽

Author(s):

Francesco Condello ◽

Gaetano Liccardo ◽

Giuseppe Ferrante

Keyword(s):

Ischemic Stroke ◽

Major Bleeding ◽

Transient Ischemic Attack ◽

Hemorrhagic Stroke ◽

Dual Antiplatelet Therapy ◽

Meta Analysis ◽

Stroke Recurrence ◽

Controlled Trials ◽

Minor Ischemic Stroke ◽

Ischemic Attack

Background: Evidence about the use of dual antiplatelet therapy (DAPT) with aspirin and P2Y12 inhibitors in patients with acute minor ischemic stroke or transient ischemic attack (TIA) is emerging. The aim of our study was to provide an updated and comprehensive analysis about the risks and benefits of DAPT versus aspirin monotherapy in this setting. Methods: The PubMed, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov databases, main international conference proceedings were searched for randomized controlled trials comparing DAPT versus aspirin monotherapy in patients with acute ischemic stroke or TIA not eligible for thrombolysis or thrombectomy presenting in the first 24 hours after the acute event. Data were pooled by meta-analysis using a random-effects model. The primary efficacy endpoint was ischemic stroke recurrence, and the primary safety outcome was major bleeding. Secondary endpoints were intracranial hemorrhage, hemorrhagic stroke, and all-cause death. Results: A total of 4 studies enrolling 21,459 patients were included. DAPT with clopidogrel was used in 3 studies, DAPT with ticagrelor in one study. DAPT duration was 21 days in one study, 1 month in one study, and 3 months in the remaining studies. DAPT was associated with a significant reduction in the risk of ischemic stroke recurrence (relative risk [RR], 0.74; 95% confidence interval [CI], 0.67-0.82, P<0.001, number needed to treat 50 [95% CI 40-72], while it was associated with a significantly higher risk of major bleeding (RR, 2.59; 95% CI 1.49-4.53, P=0.001, number needed to harm 330 [95% CI 149-1111]), of intracranial hemorrhage (RR 3.06, 95% CI 1.41-6.66, P=0.005), with a trend towards higher risk of hemorrhagic stroke (RR 1.83, 95% CI 0.83-4.05, P=0.14), and a slight tendency towards higher risk of all-cause death (RR 1.30, 95% CI 0.89-1.89, P=0.16). Conclusions: Among patients with acute minor ischemic stroke or TIA, DAPT, as compared with aspirin monotherapy, might offer better effectiveness in terms of ischemic stroke recurrence at the expense of a higher risk of major bleeding. The trade-off between ischemic benefits and bleeding risks should be assessed in tailoring the therapeutic strategies.

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Role of Perfusion-Weighted Imaging in a Diffusion-Weighted-Imaging-Negative Transient Ischemic Attack

Journal of Clinical Neurology ◽

10.3988/jcn.2017.13.2.129 ◽

2017 ◽

Vol 13 (2) ◽

pp. 129 ◽

Cited By ~ 7

Author(s):

Sang Hun Lee ◽

Hyun Wook Nah ◽

Bum Joon Kim ◽

Sung Ho Ahn ◽

Jong S. Kim ◽

...

Keyword(s):

Transient Ischemic Attack ◽

Diffusion Weighted Imaging ◽

Perfusion Weighted Imaging ◽

Diffusion Weighted ◽

Ischemic Attack

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Contribution of High-b-Value Diffusion-Weighted Imaging in Determination of Brain Ischemia in Transient Ischemic Attack Patients

Journal of Neuroimaging ◽

10.1111/j.1552-6569.2011.00696.x ◽

2012 ◽

Vol 23 (1) ◽

pp. 33-38 ◽

Cited By ~ 9

Author(s):

Francisco Purroy ◽

Robert Begue ◽

Alejandro Quílez ◽

Jordi Sanahuja ◽

Maria Isabel Gil

Keyword(s):

Brain Ischemia ◽

Transient Ischemic Attack ◽

Diffusion Weighted Imaging ◽

B Value ◽

High B Value ◽

Diffusion Weighted ◽

Ischemic Attack

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High‐resolution diffusion‐weighted imaging identifies ischemic lesions in a majority of transient ischemic attack patients

Annals of Neurology ◽

10.1002/ana.25551 ◽

2019 ◽

Vol 86 (3) ◽

pp. 452-457 ◽

Cited By ~ 4

Author(s):

Benjamin Hotter ◽

Ivana Galinovic ◽

Claudia Kunze ◽

Peter Brunecker ◽

Gerhard J. Jungehulsing ◽

...

Keyword(s):

High Resolution ◽

Transient Ischemic Attack ◽

Diffusion Weighted Imaging ◽

Diffusion Weighted ◽

Ischemic Attack

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Impact of Abnormal Diffusion-Weighted Imaging Results on Short-term Outcome Following Transient Ischemic Attack

Archives of Neurology ◽

10.1001/archneur.64.8.1105 ◽

2007 ◽

Vol 64 (8) ◽

pp. 1105 ◽

Cited By ~ 45

Author(s):

Shyam Prabhakaran ◽

Ji Y. Chong ◽

Ralph L. Sacco

Keyword(s):

Transient Ischemic Attack ◽

Diffusion Weighted Imaging ◽

Short Term ◽

Term Outcome ◽

Short Term Outcome ◽

Diffusion Weighted ◽

Imaging Results ◽

Ischemic Attack

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Optimal Timing of Diffusion-Weighted Imaging to Avoid False-Negative Findings in Patients With Transient Ischemic Attack

Stroke ◽

10.1161/strokeaha.117.014576 ◽

2017 ◽

Vol 48 (7) ◽

pp. 1990-1992 ◽

Cited By ~ 14

Author(s):

Kenji Shono ◽

Junichiro Satomi ◽

Yoshiteru Tada ◽

Yasuhisa Kanematsu ◽

Nobuaki Yamamoto ◽

...

Keyword(s):

Transient Ischemic Attack ◽

Diffusion Weighted Imaging ◽

False Negative ◽

Optimal Timing ◽

Diffusion Weighted ◽

Negative Findings ◽

Ischemic Attack

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White matter hyperintensity volume predicts persistent cognitive impairment in transient ischemic attack and minor stroke

International Journal of Stroke ◽

10.1177/1747493016676612 ◽

2016 ◽

Vol 12 (3) ◽

pp. 264-272 ◽

Cited By ~ 12

Author(s):

Leka Sivakumar ◽

Parnian Riaz ◽

Mahesh Kate ◽

Thomas Jeerakathil ◽

Christian Beaulieu ◽

...

Keyword(s):

Cognitive Impairment ◽

White Matter ◽

Transient Ischemic Attack ◽

Cognitive Assessment ◽

Diffusion Weighted Imaging ◽

Montreal Cognitive Assessment ◽

White Matter Hyperintensity ◽

Minor Stroke ◽

Diffusion Weighted ◽

Ischemic Attack

Background Temporary and permanent cognitive changes following transient ischemic attack/minor stroke have been described previously. It is unknown if persisting cognitive deficits in these patients are correlated with acute infarction identified using magnetic resonance imaging. Aims We tested the hypothesis that persistent cognitive impairment after transient ischemic attack/minor stroke can be predicted by the volume of diffusion-weighted imaging lesions. Methods Acute transient ischemic attack/minor stroke (NIH stroke scale score ≤ 3) patients were prospectively recruited within 72 h of onset. Patients underwent Montreal cognitive assessment and magnetic resonance imaging, including diffusion-weighted imaging and Fluid-Attenuated Inverse Recovery sequences, at baseline, days 7 and 30. Cognitive testing was repeated at day 90. Diffusion-weighted imaging lesion and Fluid-Attenuated Inverse Recovery chronic white matter hyperintensity volumes were measured planimetrically. Cognitive impairment was defined a priori as Montreal cognitive assessment score < 26. Results One hundred fifteen patients were imaged at a median (inter-quartile range) of 24.0 (16.6) h after onset. Acute ischemic lesions were present in 91 (79%) patients. Cognitive impairment rates were similar in patients with (47/91, 52%) and without diffusion-weighted imaging lesions (13/24, 54%; p = 0.83). Although linear regression indicated no relationship between acute diffusion-weighted imaging lesion volume and day 30 Montreal cognitive assessment scores (β = −0.163, [−2.243, 0.334], p = 0.144), white matter hyperintensity volumes at baseline were predictive of persistent cognitive deficits after 30 days (β = 2.24, [1.956, 45.369], p = 0.005). Conclusions In most transient ischemic attack/minor stroke patients who suffer acute cognitive impairment post event, deficits are temporary. Deficits after 30 days of onset are correlated with chronic white matter hyperintensity, suggesting subclinical cognitive impairment and/or impaired ability to compensate for the effects of acute ischemic infarcts.

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