scholarly journals Risk of Recurrent Ischemic Events in Patients with Symptomatic Vertebro-Basilar Stenosis

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 378-379
Author(s):  
Guven Uzun ◽  
Adnan Qureshi ◽  
Yousef M Mohammad ◽  
Osama Zaidat ◽  
Jose Suarez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Basilar Artery ◽  
Transient Ischemic Attack ◽  
Antiplatelet Agents ◽  
High Rate ◽  
First Year ◽  
Long Term Outcome ◽  
Ischemic Attack ◽  
Ischemic Events

P216 Background and Purpose: The long-term outcome in patients with symptomatic vertebro-basilar stenosis is not well defined. We performed this study to determine the long-term risk of stroke or death in a large series of patients with vertebro-basilar stenosis. Methods: We identified patients admitted between January 1995 and December 1997 with ischemic stroke or transient ischemic attack related to stenosis in either the vertebral or basilar artery at 4 university hospitals. The stenosis was identified either by magnetic resonance angiography or conventional angiography. New ischemic events or death was identified during the follow-up period through clinic visits or telephone interviews. Results: A total of 77 patients (mean age 62.4 ±13.1 years; 43 were men) were identified with stenosis of either vertebral artery (n=28), basilar artery (n=26) or both (n=22). Of the 77 patients, 18 presented with transient ischemic attack and 59 with ischemic stroke. Eight patients died during hospitalization. Of the surviving 69 patients, 24 patients were treated with aspirin, 8 with ticlopidine or clopidogrel, 36 with warfarin and one patient received no treatment. The patients were followed for 47.4 ±35.8 months after the initial event. A total of 14 recurrent ischemic events were observed. The first year risk of new ischemic events for vertebro-basilar stenosis was 9%. The first year rate of ischemic events was similar between antiplatelet agents (9%) and warfarin (8%). Conclusions: A high rate of recurrent ischemic events was observed in patients with vertebro-basilar stenosis despite treatment with antiplatelet agents or anticoagulants.

scholarly journals Antiplatelet Therapy After Noncardioembolic Stroke

Stroke ◽  
2019 ◽  
Vol 50 (7) ◽  
pp. 1812-1818 ◽  
Author(s):  
Jacoba P. Greving ◽  
Hans-Christoph Diener ◽  
Johannes B. Reitsma ◽  
Philip M. Bath ◽  
László Csiba ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Major Bleeding ◽  
Transient Ischemic Attack ◽  
Clinical Benefit ◽  
Antiplatelet Agents ◽  
Vascular Events ◽  
Subgroup Analyses ◽  
Ischemic Attack ◽  
Net Clinical Benefit

Background and Purpose— We assessed the efficacy and safety of antiplatelet agents after noncardioembolic stroke or transient ischemic attack and examined how these vary according to patients’ demographic and clinical characteristics. Methods— We did a network meta-analysis (NMA) of data from 6 randomized trials of the effects of commonly prescribed antiplatelet agents in the long-term (≥3 months) secondary prevention of noncardioembolic stroke or transient ischemic attack. Individual patient data from 43 112 patients were pooled and reanalyzed. Main outcomes were serious vascular events (nonfatal stroke, nonfatal myocardial infarction, or vascular death), major bleeding, and net clinical benefit (serious vascular event or major bleeding). Subgroup analyses were done according to age, sex, ethnicity, hypertension, qualifying diagnosis, type of vessel involved (large versus small vessel disease), and time from qualifying event to randomization. Results— Aspirin/dipyridamole combination (RR NMA-adj , 0.83; 95% CI, 0.74–0.94) significantly reduced the risk of vascular events compared with aspirin, as did clopidogrel (RR NMA-adj , 0.88; 95% CI, 0.78–0.98), and aspirin/clopidogrel combination (RR NMA-adj , 0.83; 95% CI, 0.71–0.96). Clopidogrel caused significantly less major bleeding and intracranial hemorrhage than aspirin, aspirin/dipyridamole combination, and aspirin/clopidogrel combination. Aspirin/clopidogrel combination caused significantly more major bleeding than aspirin, aspirin/dipyridamole combination, and clopidogrel. Net clinical benefit was similar for clopidogrel and aspirin/dipyridamole combination (RR NMA-adj , 0.99; 95% CI, 0.93–1.05). Subgroup analyses showed no heterogeneity of treatment effectiveness across prespecified subgroups. The excess risk of major bleeding associated with aspirin/clopidogrel combination compared with clopidogrel alone was higher in patients aged <65 years than it was in patients ≥65 years (RR NMA-adj , 3.9 versus 1.7). Conclusions— Results favor clopidogrel and aspirin/dipyridamole combination for long-term secondary prevention after noncardioembolic stroke or transient ischemic attack, regardless of patient characteristics. Aspirin/clopidogrel combination was associated with a significantly higher risk of major bleeding compared with other antiplatelet regimens.

scholarly journals High ABCD2 Scores and In-Hospital Interventions following Transient Ischemic Attack

2016 ◽  
Vol 6 (3) ◽  
pp. 76-83 ◽  
Author(s):  
Shawna Cutting ◽  
Elizabeth Regan ◽  
Vivien H. Lee ◽  
Shyam Prabhakaran
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Heart Association ◽  
Reperfusion Therapy ◽  
Large Artery ◽  
Increased Risk ◽  
Risk Patients ◽  
Abcd2 Score ◽  
Ischemic Attack ◽  
Ischemic Events

Background and Purpose: Following transient ischemic attack (TIA), there is increased risk for ischemic stroke. The American Heart Association recommends admission of patients with ABCD2 scores ≥3 for observation, rapid performance of diagnostic tests, and potential acute intervention. We aimed to determine if there is a relationship between ABCD2 scores, in-hospital ischemic events, and in-hospital treatments after TIA admission. Methods: We reviewed consecutive patients admitted between 2006 and 2011 following a TIA, defined as transient focal neurological symptoms attributed to a specific vascular distribution and lasting <24 h. Three interventions were prespecified: anticoagulation for atrial fibrillation, carotid or intracranial revascularization, and intravenous or intra-arterial reperfusion therapies. We compared rates of in-hospital recurrent TIA or ischemic stroke and the receipt of interventions among patients with low (<3) versus high (≥3) ABCD2 scores. Results: Of 249 patients, 11 patients (4.4%) had recurrent TIAs or strokes during their stay (8 TIAs, 3 strokes). All 11 had ABCD2 scores ≥3, and no neurological events occurred in patients with lower scores (5.1 vs. 0%; p = 0.37). Twelve patients (4.8%) underwent revascularization for large artery stenosis, 16 (6.4%) were started on anticoagulants, and no patient received intravenous or intra-arterial reperfusion therapy. The ABCD2 score was not associated with anticoagulation (p = 0.59) or revascularization (p = 0.20). Conclusions: Higher ABCD2 scores may predict early ischemic events after TIA but do not predict the need for intervention. Outpatient evaluation for those with scores <3 would potentially have delayed revascularization or anticoagulant treatment in nearly one-fifth of ‘low-risk' patients.

scholarly journals Antithrombotic Prescription at Discharge in Medicare Patients with Ischemic Stroke/Transient Ischemic Attack: Results from the National Stroke Project

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 376-377
Author(s):  
Timothy F Kresowik ◽  
David S Nilasena ◽  
Anton F Piskac ◽  
Rebecca A Hemann ◽  
Marian A Brenton ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Stroke Prevention ◽  
Antiplatelet Agents ◽  
Secondary Stroke Prevention ◽  
Antithrombotic Agents ◽  
Patterns Of Use ◽  
Medicare Patients ◽  
Ischemic Attack ◽  
Univariate Analyses

P205 Background: Antiplatelet agents have been shown to be effective for secondary stroke prevention in patients with ischemic stroke (IS) or transient ischemic attack (TIA). As part of HCFA’s National Stroke Project, we examined patterns of use of antithrombotic agents for inpatients with IS or TIA. Methods: Findings were based on abstracted data from a sample of Medicare inpatient medical records (discharge dates 4/98 - 3/99). All U.S. states, the District of Columbia and Puerto Rico were sampled using a systematic random approach. Each record had a principal diagnosis of one of the following ICD-9-CM codes: 362.34, 433.xx, 434.xx, 435.0, 435.1, 435.3, 435.8, 435.9 or 436. The main outcome measure was the frequency of eligible patients with a prescription or a plan for antithrombotic therapy at discharge. Antithrombotics were aspirin, clopidogrel, dipyridamole, ticlopidine and warfarin. Results: Of the 36,650 cases reviewed, 25,659 met the criteria for inclusion in the indicator. A large percentage of excluded cases (53.1%) were removed due to a history or current finding of hemorrhage. Nationwide, 20,947 (unadjusted rate 81.6%) patients were prescribed an antithrombotic at discharge or had a plan for starting an antithrombotic after discharge. The state-specific rates ranged from 72.0% to 90.1%. Univariate analyses showed this therapy was prescribed less frequently (p<0.001) for adults 85 years and over (rate=77.8%, OR=0.74, 95% CI=0.69–0.80), women (rate=80.4%, OR=0.83, 95% CI=0.78–0.89) and African-Americans (rate=77.6%, OR=0.76, 95% CI=0.68–0.85). Asians were found to have been prescribed this therapy more frequently than other races (p<0.02, rate=87.2%, OR=1.54 95% CI=1.10–2.16). Among those IS/TIA patients who also had atrial fibrillation (AF), 57.1% received warfarin. Conclusions: Antithrombotic agents are not prescribed for almost one-fifth of eligible Medicare inpatients with IS/TIA. For those with IS/TIA and AF, a large proportion are not treated with warfarin. These results show important opportunities for improvement in secondary stroke prevention for Medicare patients.

scholarly journals Antiplatelet therapy in stroke prevention after non-cardioembolic transient ischemic attack

2021 ◽  
Vol 13 (5) ◽  
pp. 14-19
Author(s):  
A. V. Fonyakin ◽  
L. A. Geraskina ◽  
M. Yu. Maksimova
Keyword(s):  
Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Transient Ischemic Attack ◽  
Antiplatelet Agents ◽  
Basic Principles ◽  
Advantages And Disadvantages ◽  
Minor Ischemic Stroke ◽  
New Ideas ◽  
Ischemic Attack

The review shows modern concepts on the role of antiplatelet therapy in the secondary prevention of cardiovascular diseases in patients after non-cardioembolic ischemic stroke or transient ischemic attack (TIA). We present an analytical characteristic of all antiplatelet agents that have been studied in randomized controlled trials worldwide. We demonstrate the advantages and disadvantages of each agent in monotherapy and in combination. New ideas about the rationality of the use of combined antiplatelet therapy with clopidogrel and acetylsalicylic acid in the first 24 hours and no more than 90 days in patients with minor ischemic stroke or TIA are discussed. The efficacy and safety of new antiplatelet agents are analyzed. The basic principles of choosing antiplatelet agents in patients after ischemic noncardioembolic stroke/TIA are outlined.

scholarly journals Comparison of Carotid Atherosclerotic Plaque Characteristics between Symptomatic Patients with Transient Ischemic Attack and Stroke using High-Resolution Magnetic Resonance Imaging

2021 ◽  
Author(s):  
Mingming Lu ◽  
Lichen Zhang ◽  
Fei Yuan ◽  
Peng Peng ◽  
Hongtao Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Transient Ischemic Attack ◽  
Carotid Arteries ◽  
Plaque Burden ◽  
Plaque Morphology ◽  
Stroke Patients ◽  
Carotid Plaques ◽  
Ischemic Attack ◽  
Ischemic Events

Abstract Background:This study aimed to compare the characteristics of carotid plaques between patients with transient ischemic attack (TIA) and ischemic stroke using magnetic resonance (MR) imaging.Methods：Patients with a recent ischemic stroke or TIA who exhibited atherosclerotic plaques of carotid arteries in the symptomatic sides determined by MR vessel wall imaging were recruited. The plaque morphology and compositions including intraplaque hemorrhage (IPH), lipid-rich necrotic-core (LRNC) and calcification were compared between TIA and stroke patients. Logistic regression was performed to relate the plaque characteristics to the types of ischemic events.Results:A total of 270 patients with TIA or ischemic stroke were recruited. Stroke patients had significantly higher prevalence of diabetes (42.2% vs. 28.2%, p=0.021), greater mean wall area (35.1 ± 10.1 mm2 vs. 32.0 ± 7.7 mm2, p = 0.004), mean wall thickness (1.3 ± 0.2 mm vs. 1.2 ± 0.2 mm, p=0.001), maximum normalized wall index (NWI)(63.9% ± 6.0% vs. 62.2% ± 5.9%, p=0.023) and %volume of LRNC (9.7%± 8.2% vs. 7.4% ±7.9%, p=0.025) in carotid arteries compared to those with TIA. After adjusted for clinical factors, above characteristics of carotid arteries were significantly associated with the type of ischemic events. After further adjusted for maximum NWI, this association remained statistically significant (OR, 1.41; CI, 1.01-1.96; p=0.041).Conclusions:Ischemic stroke patients had larger plaque burden and greater proportion of LRNC in carotid plaques compared to those with TIA. This study suggests that ischemic stroke patients had more vulnerable plaques compared to those with TIA.

scholarly journals Depression and Diabetes Mellitus Multimorbidity Is Associated With Loss of Independence and Dementia Poststroke

Stroke ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 3531-3540
Author(s):  
Michael Ouk ◽  
Che-Yuan Wu ◽  
Jessica Colby-Milley ◽  
Jiming Fang ◽  
Limei Zhou ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Long Term Care ◽  
Stroke Recovery ◽  
Term Care ◽  
Incident Dementia ◽  
All Cause Mortality ◽  
Ischemic Attack

Background and Purpose: Many patients with ischemic stroke present with multiple comorbidities that threaten survival and recovery. This study sought to determine the risks of adverse long-term stroke outcomes associated with multimorbid diabetes mellitus and depression. Methods: Retrospective analysis of prospectively collected data on consecutive patients without premorbid dementia admitted from the community for a first-ever acute ischemic stroke to comprehensive stroke centers across Ontario, Canada (2003–2013). Premorbid histories of diabetes mellitus and depression were ascertained within 5 years before stroke admission. Adjusted hazard ratios (aHR [95% CI]) of admission to long-term care, incident dementia, readmission for stroke or transient ischemic attack and all-cause mortality, over time among those discharged back into the community poststroke. Results: Among 23 579 stroke admissions, n=20 201 were discharged back into the community. Diabetes mellitus and depression were associated with synergistic hazards of admission to long-term care (X 2 =5.4; P =0.02) over a median follow-up of 5.6 years. This interaction was observed among women specifically; depression multimorbidity showed particularly high hazards of admission to long-term care (aHR Depression =1.57 [1.24–1.98]) and incident dementia (aHR Depression =1.85 [1.40–2.44]) among women with diabetes mellitus. In the whole cohort, diabetes mellitus and depression were associated individually with long-term care admission (aHR Diabetes =1.20 [1.12–1.29]; aHR Depression =1.19 [1.04–1.37]), incident dementia (aHR Diabetes =1.14 [1.06–1.23]; aHR Depression =1.27 [1.08–1.49]), stroke/transient ischemic attack readmission (aHR Diabetes =1.18 [1.10–1.26]; aHR Depression =1.24 [1.07–1.42]), and all-cause mortality (aHR Diabetes =1.29 [1.23–1.36]; aHR Depression =1.16 [1.05–1.29]). Conclusions: The risks of dementia and needing long-term care in the years after surviving a stroke were particularly elevated among women when premorbid diabetes mellitus and depression occurred together. Long-term stroke recovery strategies might target high-risk patients with mood and metabolic multimorbidity.

scholarly journals Time Course for Benefit and Risk of Clopidogrel and Aspirin After Acute Transient Ischemic Attack and Minor Ischemic Stroke

Circulation ◽  
2019 ◽  
Vol 140 (8) ◽  
pp. 658-664 ◽  
Author(s):  
S. Claiborne Johnston ◽  
Jordan J. Elm ◽  
J. Donald Easton ◽  
Mary Farrant ◽  
William G. Barsan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
High Risk ◽  
Transient Ischemic Attack ◽  
Time Course ◽  
Hazard Ratio ◽  
Major Hemorrhage ◽  
Minor Ischemic Stroke ◽  
Ischemic Attack ◽  
Ischemic Events ◽  
Benefit And Risk

Background: In patients with acute minor ischemic stroke or high-risk transient ischemic attack enrolled in the POINT trial (Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke [POINT] Trial), the combination of clopidogrel and aspirin for 90 days reduced major ischemic events but increased major hemorrhage in comparison to aspirin alone. Methods: In a secondary analysis of POINT (N=4881), we assessed the time course for benefit and risk from the combination of clopidogrel and aspirin. The primary efficacy outcome was a composite of ischemic stroke, myocardial infarction, or ischemic vascular death. The primary safety outcome was major hemorrhage. Risks and benefits were estimated for delayed times of treatment initiation using left-truncated models. Results: Through 90 days, the rate of major ischemic events was initially high then decreased markedly, whereas the rate of major hemorrhage remained low but relatively constant throughout. With the use of a model-based approach, the optimal change point for major ischemic events was 21 days (0–21 days hazard ratio 0.65 for clopidogrel-aspirin versus aspirin; 95% CI, 0.50–0.85; P =0.0015, in comparison to 22–90 days hazard ratio, 1.38; 95% CI, 0.81–2.35; P =0.24). Models showed benefits of clopidogrel-aspirin for treatment delayed as long as 3 days after symptom onset. Conclusions: The benefit of clopidogrel-aspirin occurs predominantly within the first 21 days, and outweighs the low, but ongoing risk of major hemorrhage. When considered with the results of the CHANCE trial (Clopidogrel in High-Risk Patients With Non-disabling Cerebrovascular Events), a similar trial treating with clopidogrel-aspirin for 21 days and showing no increase in major hemorrhage, these results suggest that limiting clopidogrel-aspirin use to 21 days may maximize benefit and reduce risk after high-risk transient ischemic attack or minor ischemic stroke. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00991029.

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