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.

scholarly journals Is diabetes a marker of higher risk after carotid revascularization? Experience from a single centre

2018 ◽  
Vol 15 (4) ◽  
pp. 314-321 ◽  
Author(s):  
Renato Casana ◽  
Chiara Malloggi ◽  
Andrea Odero ◽  
Valerio Tolva ◽  
Richard Bulbulia ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Transient Ischaemic Attack ◽  
Carotid Artery Stenting ◽  
Single Centre ◽  
Carotid Revascularization ◽  
Patients With Diabetes ◽  
Single Centre Study ◽  
Ischaemic Attack

Purpose: This single centre study investigates the influence of diabetes mellitus on outcomes following carotid artery endarterectomy or stenting. Methods: In total, 752 carotid revascularizations (58.2% carotid artery stenting and 41.8% carotid endarterectomy) were performed in 221 (29.4%) patients with diabetes and 532 (70.6%) patients without diabetes. The study outcomes were death, disabling and non-disabling stroke, transient ischaemic attack and restenosis within 36 months after the procedure. Results: Patients with diabetes had higher periprocedural risk of any stroke or death (3.6% diabetes vs 0.6% no diabetes; p < 0.05), transient ischaemic attack (1.8% diabetes vs 0.2% no diabetes; p > 0.05) and restenosis (2.7% diabetes vs 0.6% no diabetes; p < 0.05). During long-term follow-up, there were no significant differences in Kaplan–Meier estimates of freedom from death, any stroke and transient ischaemic attack, between people with and without diabetes for each carotid artery stenting and carotid endarterectomy subgroup. Patients with diabetes showed higher rates of restenosis during follow-up than patients without diabetes (36-months estimate risk of restenosis: 21.2% diabetes vs 12.5% no diabetes; p < 0.05). Conclusion: The presence of diabetes was associated with increased periprocedural risk, but no further additional risk emerged during longer term follow-up. Restenosis rates were higher among patients with diabetes.

History of transient ischaemic attack, myocardial infarction and hyperlipidaemia affects outcome following carotid artery stenting

2015 ◽  
Vol 11 (8) ◽  
pp. 808-815 ◽  
Author(s):  
Roland Richard Macharzina ◽  
Christian Claus ◽  
Steven R. Messé ◽  
Tanja Boehme ◽  
Werner Vach ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Carotid Artery ◽  
Transient Ischaemic Attack ◽  
Carotid Artery Stenting ◽  
History Of ◽  
Ischaemic Attack

scholarly journals Short-term outcomes of Chinese transient ischaemic attack patients in an Emergency department in Hong Kong: Result of management with an agreed protocol with neurologists

2021 ◽  
pp. 102490792110043
Author(s):  
Simon Lai Hong Chiu ◽  
William Cheung Lun Wong ◽  
Ellen Lok Man Yu
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Transient Ischaemic Attack ◽  
Stroke Risk ◽  
Area Under The Curve ◽  
Predictive Ability ◽  
Short Term ◽  
Neurosurgical Department ◽  
Transient Ischaemic Attacks ◽  
Ischaemic Attack

Introduction: Emergency department management of transient ischaemic attack varies from admission for all to outpatient referral. We studied the short-term outcomes of transient ischaemic attack managed with an agreed protocol. Predictors of stroke can be different for Asians and non-Asians. ABCD2 as initial triage of transient ischaemic attack is debatable. The predictive ability of ABCD2 score was studied as well. Methods: This was a prospective observational study with consecutive subject recruitment in Emergency department. All transient ischaemic attacks were admitted, hard and e-records of Emergency department, transient ischaemic attack clinic, Medical and Neurosurgical department and general follow-ups in Hospital Authority hospitals were studied up to 1 year. Stroke-day was measured from symptom-onset to time-of-stroke. Results: In 18-month period, 124 patients were recruited. The median onset-to-door time was 3.5 h. All computed tomography brain positive findings, except one subdural haematoma, were ischaemic in origin. Six strokes, all disabling, recurred within 90 days, three on day 1–3, two died in 6 months. The stroke risks at 2, 7, 90 days and 1 year were 1.61%, 3.23%, 4.84% and 4.84%, respectively. No significant trend was observed in stroke risk across ABCD2 scores ( p = 0.783) with area under the curve of 0.537 (95% confidence interval = 0.380–0.694; p = 0.762). The short-term stroke risk was associated with atrial fibrillation ( p = 0.002). The median Emergency Medicine ward length of stay was 1.33 days. Conclusion: In our Emergency department–based management, the short-term stroke risk of transient ischaemic attack is low, and the predictivity of ABCD2 score in risk stratification cannot be validated. Stroke recurrences were associated with atrial fibrillation. A low ABCD2 could be falsely reassuring. As half of the strokes recurred very early, we recommend admission in the hyperacute phase.

Differential Effects of Carotid Artery Stenting Versus Carotid Endarterectomy on External Carotid Artery Patency

2007 ◽  
Vol 14 (2) ◽  
pp. 208-213 ◽  
Author(s):  
Edward Y. Woo ◽  
Jagajan Karmacharya ◽  
Omaida C. Velazquez ◽  
Jeffrey P. Carpenter ◽  
Christopher L. Skelly ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenting ◽  
External Carotid Artery ◽  
External Carotid ◽  
Differential Effects

Computer Simulation to Estimate the Effectiveness of Carotid Endarterectomy

1998 ◽  
Vol 3 (1) ◽  
pp. 6-11 ◽  
Author(s):  
Michael Lavender ◽  
Neil Craig ◽  
Ron Kerr ◽  
Denise Howel
Keyword(s):  
Sensitivity Analysis ◽  
Computer Simulation ◽  
Medical Treatment ◽  
Carotid Endarterectomy ◽  
Transient Ischaemic Attack ◽  
Cost Effective ◽  
Baseline Scenario ◽  
Cost Information ◽  
Patient Groups ◽  
Ischaemic Attack

Objectives: To investigate the benefit of carotid endarterectomy relative to medical treatment, by comparing the outcome for different groups of patients following transient ischaemic attacks. Methods: A Markov model was used to describe the survival and quality of life of patients treated for a transient ischaemic attack. The benefit is measured in terms of quality adjusted life months (QALMs). The outcome was estimated using a computer simulation with parameters based on published studies on the probability of events following treatment. The benefit of carotid endarterectomy was explored using a baseline set of parameters and a sensitivity analysis. Results: The baseline scenario of a 65-year-old male patient with the model factors set at an intermediate level showed a benefit for surgery of 3 QALMs compared with medical treatment alone. The sensitivity analysis showed that the most favourable combination of factors had a benefit of 13.4 QALMs and the least favourable a loss of 2 QALMs. Of all 128 factor combinations, 79.9% showed a benefit for surgery, 5.5% showed equal benefit, and 15.6% showed a benefit for medical treatment. Conclusions: Computer simulations have the potential for deriving estimates of benefit for different patient groups from the results of clinical trials. Combined with reliable information on costs, the technique could also demonstrate variations in cost-effectiveness for these groups. For patients following a transient ischaemic attack, the results from this simulation and limited cost information suggest that carotid endarterectomy is unlikely to be a cost-effective intervention in the UK for many patient groups despite a reduction in the risk of stroke.

Sign in / Sign up

Export Citation Format

Share Document