Age but not ABCD2score predicts any level of carotid stenosis in either symptomatic or asymptomatic side in transient ischaemic attack

2015 ◽  
Vol 69 (9) ◽  
pp. 948-956 ◽  
Author(s):  
G. S. Mannu ◽  
M. M. Kyu ◽  
J. H. Bettencourt-Silva ◽  
Y. K. Loke ◽  
A. B. Clark ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Transient Ischaemic Attack ◽  
Ischaemic Attack

scholarly journals Relationship between Lipoprotein (a) and Both Stroke and Carotid Atheroma

1997 ◽  
Vol 34 (4) ◽  
pp. 360-365 ◽  
Author(s):  
Hugh S Markus ◽  
Rupal Kapadia ◽  
Roy A Sherwood
Keyword(s):  
Carotid Stenosis ◽  
Patient Group ◽  
Transient Ischaemic Attack ◽  
Case Control Studies ◽  
Stroke Subtype ◽  
Lipoprotein A ◽  
Unselected Population ◽  
Ischaemic Attack ◽  
The Relationship

In vitro studies provide mechanisms by which elevated lipoprotein(a) [Lp(a)] concentrations may promote both thrombosis and atherogenesis. Case-control studies have reported raised Lp(a) concentrations in patients with stroke, but prospective studies have failed to confirm the association. A potential confounding factor is that Lp(a) may rise acutely after stroke. We determined Lp(a) concentrations in 164 patients studied at least 21 days after stroke or transient ischaemic attack, and in 91 controls. In the patient group we correlated Lp(a) concentrations with both the degree of carotid stenosis estimated on duplex ultrasonography, and with stroke subtype (large vessel disease, lacunar infarction, and cardioembolic and unknown pathogenesis). There was no difference between Lp(a) concentration in cases and controls [median (quartiles) 0·10 (0·04, 0·39) versus 0·12 (0·04, 0·30) g/L, P = 0·34]. There was no difference in the proportion of cases compared with controls with a markedly elevated Lp(a) of > 0·4g/L (21·3 versus 16·5%, P = 0·34). There was non-significant trend towards higher median Lp(a) concentrations in women [median (quartiles) 0·16 (0·04, 0·32)g/L versus 0·12 (0·04, 0·28) g/L, P = 0·3]. In view of this trend we analysed the differences between cases and controls for each sex separately. Lp(a) concentrations in men were median (quartiles) 0·08 (0·04, 0·26)g/L in the 101 cases and 0·12 (0·04, 0·28) g/L in the 43 controls ( P = 0·6). Lp(a) concentrations in women were median (quartiles) 0·25 (0·04, 0·44) g/L in the 63 cases, and 0·16 (0·04, 0·32) g/L in the 48 controls ( P = 0·16). Within the patient group there was no difference between Lp(a) concentrations in the different stroke subgroups. There was no relationship between Lp(a) concentrations and mean percentage carotid stenosis ( rs = 0·14, P = 0·07). Our results suggest that in an unselected population of men studied more than 3 weeks post event there is no relationship between lipoprotein(a) concentrations and either stroke/transient ischaemic attack, or carotid atheroma. The relationship in women requires further study.

scholarly journals Carotid artery stenosis, an underestimated cause of stroke recurrence in patients with ischaemic monocular visual loss

2019 ◽  
Vol 101 (8) ◽  
pp. 579-583
Author(s):  
SF Cheng ◽  
A Zarkali ◽  
T Richards ◽  
R Simister ◽  
A Chandratheva
Keyword(s):  
Carotid Stenosis ◽  
Transient Ischaemic Attack ◽  
Visual Loss ◽  
Surgical Intervention ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Ischaemic Attack ◽  
Transient Visual Loss

Introduction Isolated monocular ischaemic events are thought to be low risk for stroke recurrence. In the presence of carotid stenosis however, the risks should not be treated similarly and surgical intervention should be considered at an early stage. The aim of this study was to determine the vascular risk profile and stroke recurrence in patients with ischaemic monocular visual loss. Methods and methods Consecutive records for all patients with monocular ischaemia were reviewed from January 2014 to October 2016. Stroke, transient ischaemic attack or monocular ischaemia recurrence within 90 days were recorded. Carotid stenosis was assessed with duplex ultrasound, computed tomography or magnetic resonance angiography. Results In total, 400 patients presented with monocular ischaemia; 391 had carotid imaging (97.8%). Causality was symptomatic carotid stenosis ≥ 50% in 53 (13.6%), including carotid stenosis ≥ 70% in 31 (7.9%). Patients with permanent visual loss (n = 131) were more likely to have significant stenosis compared with patients with transient visual loss (n = 260), 19.8% compared with 10.4% (P = 0.012). Recurrent stroke, transient ischaemic attack or monocular ischaemia within 90 days after presentation occurred in three patients (5.7%) in the carotid stenosis group, compared to three (0.9%) who did not have stenosis (P = 0.035). Age, male sex and hypertension were associated with carotid stenosis but hypercholesterolaemia, diabetes and smoking were not. Conclusions Carotid stenosis ≥ 50% is present in patients with ocular ischaemia in approximately 20% of those with persistent visual loss and in 10% with transient visual loss. Those with carotid stenosis have a higher risk of stroke recurrence and should be considered urgent surgical intervention as other forms of stroke.

scholarly journals Secondary prevention medication persistence and prognosis of acute ischaemic stroke or transient ischaemic attack

2021 ◽  
pp. svn-2020-000471
Author(s):  
Lei Zhang ◽  
Junfeng Shi ◽  
Yuesong Pan ◽  
Zixiao Li ◽  
Hongyi Yan ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Transient Ischaemic Attack ◽  
Recurrent Stroke ◽  
Medication Persistence ◽  
Level Ii ◽  
Composite Events ◽  
Ischaemic Attack ◽  
Level I

IntroductionThe risk of disability and mortality is high among recurrent stroke, which highlights the importance of secondary prevention measures. We aim to evaluate medication persistence for secondary prevention and the prognosis of acute ischaemic stroke or transient ischaemic attack (TIA) in China.MethodsPatients with acute ischaemic stroke or TIA from the China National Stroke Registry II were divided into 3 groups based on the percentage of persistence in secondary prevention medication classes from discharge to 3 months after onset (level I: persistence=0%, level II: 0%<persistence<100%, level III: persistence=100%). The primary outcome was recurrent stroke. The secondary outcomes included composite events (stroke, myocardial infarction or death from cardiovascular cause), all-cause death and disability (modified Rankin Scale score=3–5) from 3 months to 1 year after onset. Recurrent stroke, composite events and all-cause death were performed using Cox regression model, and disability was identified through logistic regression model using the generalised estimating equation method.Results18 344 patients with acute ischaemic stroke or TIA were included, 315 (1.7%) of whom experienced recurrent strokes. Compared with level I, the adjusted HR of recurrent stroke for level II was 0.41 (95% CI 0.31 to 0.54) and level III 0.37 (0.28 to 0.48); composite events for level II 0.41 (0.32 to 0.53) and level III 0.38 (0.30 to 0.49); all-cause death for level II 0.28 (0.23 to 0.35) and level III 0.20 (0.16–0.24). Compared with level I, the adjusted OR of disability for level II was 0.89 (0.77 to 1.03) and level III 0.82 (0.72 to 0.93).ConclusionsPersistence in secondary prevention medications, especially in all classes of medications prescribed by the physician, was associated with lower hazard of recurrent stroke, composite events, all-cause death and lower odds of disability in patients with acute ischaemic stroke or TIA.

scholarly journals Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study

BMJ ◽  
2021 ◽  
pp. n49
Author(s):  
Jeffrey J Perry ◽  
Marco L A Sivilotti ◽  
Marcel Émond ◽  
Ian G Stiell ◽  
Grant Stotts ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Carotid Artery ◽  
Confidence Interval ◽  
Carotid Endarterectomy ◽  
Likelihood Ratio ◽  
Transient Ischaemic Attack ◽  
Carotid Artery Stenting ◽  
Stroke Risk ◽  
Ischaemic Attack

Abstract Objective To validate the previously derived Canadian TIA Score to stratify subsequent stroke risk in a new cohort of emergency department patients with transient ischaemic attack. Design Prospective cohort study. Setting 13 Canadian emergency departments over five years. Participants 7607 consecutively enrolled adult patients attending the emergency department with transient ischaemic attack or minor stroke. Main outcome measures The primary outcome was subsequent stroke or carotid endarterectomy/carotid artery stenting within seven days. The secondary outcome was subsequent stroke within seven days (with or without carotid endarterectomy/carotid artery stenting). Telephone follow-up used the validated Questionnaire for Verifying Stroke Free Status at seven and 90 days. All outcomes were adjudicated by panels of three stroke experts, blinded to the index emergency department visit. Results Of the 7607 patients, 108 (1.4%) had a subsequent stroke within seven days, 83 (1.1%) had carotid endarterectomy/carotid artery stenting within seven days, and nine had both. The Canadian TIA Score stratified the risk of stroke, carotid endarterectomy/carotid artery stenting, or both within seven days as low (risk ≤0.5%; interval likelihood ratio 0.20, 95% confidence interval 0.09 to 0.44), medium (risk 2.3%; interval likelihood ratio 0.94, 0.85 to 1.04), and high (risk 5.9% interval likelihood ratio 2.56, 2.02 to 3.25) more accurately (area under the curve 0.70, 95% confidence interval 0.66 to 0.73) than did the ABCD2 (0.60, 0.55 to 0.64) or ABCD2i (0.64, 0.59 to 0.68). Results were similar for subsequent stroke regardless of carotid endarterectomy/carotid artery stenting within seven days. Conclusion The Canadian TIA Score stratifies patients’ seven day risk for stroke, with or without carotid endarterectomy/carotid artery stenting, and is now ready for clinical use. Incorporating this validated risk estimate into management plans should improve early decision making at the index emergency visit regarding benefits of hospital admission, timing of investigations, and prioritisation of specialist referral.

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