Abstract 2739: Cardioembolic Stroke Is Frequent in the Late Recurrence After Transient Ischemic Attack

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Takao Hoshino ◽  
Takehiko Nagao ◽  
Satoko Mizuno ◽  
Satoru Shimizu ◽  
Shinichiro Uchiyama
Keyword(s):  
Transient Ischemic Attack ◽  
Clinical Characteristics ◽  
Recurrent Stroke ◽  
Late Recurrence ◽  
Early Recurrence ◽  
Cardioembolic Stroke ◽  
Stroke Patients ◽  
Ischemic Attack ◽  
Recurrence Group ◽  
Group 1

Background The high risk of stroke after transient ischemic attack (TIA) has been widely recognized, although the differences of clinical characteristics between early and late recurrent stroke were not well-known. Materials and methods The subjects were 133 consecutive ischemic stroke patients who were admitted to our hospital within one week of onset, and had previously diagnosed as “definite TIA” by trained stroke neurologists. They were divided into five groups according to the interval between prior TIA and subsequent stroke; (1) within 48 hours, (2) 48 hours to 1 week, (3) 1 week to 1 month, (4) 1 month to 3 months, and (5) after 3 months (group 1 to 5, respectively). Then, we compared clinical characteristics and prognosis between the patients who presented recurrent stroke within and after 1 week subsequent to TIA (early recurrence group and late recurrence group, respectively). Results Of the 133 acute stroke patients (mean age 69.9 years, male 66.9%), 46 (34.9%) were in group 1, 28 (21.2%) in group 2, 23 (17.4%) in group 3, 18 (13.6%) in group 4, and 17 (12.9%) in group 5. As to stroke subtypes, most of the non-cardioembolic strokes were frequently observed shortly after TIA, while the percentage of cardioembolism remained high even the time from prior TIA passed ( Figure ). The prevalence of atrial fibrillation (Af) was higher (39.7% vs. 21.3%, P =0.034), and dyslipidemia was lower (41.4% vs. 64.0%, P =0.014) in the late recurrence group than in the early recurrence group. The percentages of patients with hypertension, diabetes mellitus, and higher ABCD 2 score (≥3 or ≥5) were similar in both groups. Among 42 patients with Af, 14 (33.3%) were premorbid, 16 (38.1%) were diagnosed when TIA presented, and 12(28.6%) were diagnosed when stroke presented. In the late recurrence group, 37/58 patients (63.8%) had a poor outcome (modified Rankin Scale ≥3) at 3 month of stroke onset, significantly higher than the 29/75 (38.7%) patients in the early recurrence group ( P =0.005). Conclusions The frequency of cardioembolic stroke dose not decline during the time course after TIA, while most of the non-cardioembolic stroke recur early after TIA. This might be responsible for the poorer functional outcome in late recurrent stroke. More than quarter of Af patients had been asymptomatic before stroke, which suggests the need for repeated examinations to detect Af in patients with TIA of unknown etiology.

Abstract 41: Prognostic Value of Perfusion MRI in Patients with Transient Ischemic Attack or Minor Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Joon Hwa Lee ◽  
Hyunjin Jo ◽  
Jihoon Cha ◽  
Woo-Keun Seo ◽  
Oh Young Bang ◽  
...  
Keyword(s):  
Cardiovascular Event ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Perfusion Mri ◽  
Minor Stroke ◽  
Secondary Outcome ◽  
Stroke Recurrence ◽  
Composite Outcome ◽  
Stroke Patients ◽  
Ischemic Attack

Background and purpose: We aimed to investigate the role of perfusion MRI parameters (TTP: time to peak, CBF: cerebral blood flow, CBV: cerebral blood volume) as a prognostic factor for the risk of stroke recurrence or cardiovascular outcome in patients with transient ischemic attack (TIA) or minor stroke. Methods: We retrospectively reviewed TIA or minor stroke patients who underwent our stroke MRI protocol (DWI, perfusion MRI, and MRA) in a consecutively collected stroke registry. Primary outcome was nonfatal stroke recurrence and secondary outcome was cardiovascular composite outcome. Multivariate analysis was used to examine the association of perfusion MRI parameters and angiographic findings with the risk of stroke recurrence and cardiovascular event. Results: Of the 326 patients who met inclusion criteria, we identified 15(4.6%) nonfatal strokes and 25(7.7%) cardiovascular composite events during the first 1 year after the index TIA or minor stroke. The presence of regional delayed perfusion on TTP maps (p=0.002) and regional hyperperfusion on CBV maps (p<0.001) were associated with recurrent stroke. In MRA images, concomitant stenosis of the intracranial arteries and/or extracranial carotid arteries was associated with cardiovascular events (p=0.009). Using multivariate cox proportional hazard analysis, presence of regional hyperperfusion on CBV remained an independent predictor of recurrent stroke (HR 10.82, 95% CI 4.19-38.67, p<0.001) and cardiovascular event (HR 6.30, 95% CI 2.67-18.25, p<0.001). The AUC of the CBV maps was also greater than other parameters for the prediction of stroke recurrence (AUC=0.701, 95% CI 0.54-0.86) and cardiovascular composite outcome (AUC=0.628, 95% CI 0.50-0.76). Conclusions: Increased CBV on perfusion MRI, representing the hemodynamic status of postischemic hyperperfusion, could be more useful than other perfusion parameters in predicting poor prognosis of TIA or minor stroke patients.

Cardioembolic Stroke is Frequent in Late Recurrence After Transient Ischemic Attack

2013 ◽  
Vol 22 (6) ◽  
pp. 822-827 ◽  
Author(s):  
Takao Hoshino ◽  
Takehiko Nagao ◽  
Satoko Mizuno ◽  
Satoru Shimizu ◽  
Shinichiro Uchiyama
Keyword(s):  
Transient Ischemic Attack ◽  
Late Recurrence ◽  
Cardioembolic Stroke ◽  
Ischemic Attack

scholarly journals Risk Factor Management with Guideline-Based Medications for Prevention of Recurrent Ischemic Stroke: A Retrospective Chart Review

2017 ◽  
Vol 8 (4) ◽  
pp. 5
Author(s):  
Jessica S. Rose ◽  
Jeffrey A. Kyle ◽  
Jessica W. Skellley
Keyword(s):  
Transient Ischemic Attack ◽  
Stroke Prevention ◽  
Chart Review ◽  
Recurrent Stroke ◽  
Retrospective Chart Review ◽  
Cardioembolic Stroke ◽  
Secondary Stroke Prevention ◽  
Number Of Patients ◽  
Appropriate Prescribing ◽  
Ischemic Attack

Background: Implementation of new practice guidelines for stroke prevention has decreased the number of patients experiencing recurrent stroke. Clinical trials show antihypertensives, high-intensity statins, and antithrombotics to be beneficial after stroke. Objective: The objective of this study was to determine if recurrent stroke patients were discharged on guideline-based medications for secondary stroke prevention, and to identify potential errors in appropriate prescribing of medications. Methods: A retrospective chart review was conducted at a community hospital and included patients 19 years and older diagnosed with their second, third, or fourth stroke (transient ischemic attack or cerebrovascular accident). Descriptive statistics were used to describe collected information. Collected data included relevant patient demographics, diagnosis, past medical history, medications, and readmission rates. The primary objective was the percentage of patients appropriately discharged on guideline-based secondary stroke prevention medications. Appropriate treatment was based upon the 2010 and 2014 American Heart Association/American Stroke Association Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack. Results: A total of 124 charts were reviewed, 106 charts met the inclusion criteria. Guideline-based and appropriate medication-use was initiated in 9% and 4% of patients with noncardioembolic and cardioembolic stroke, respectively. Therapy deemed not guideline-based, but appropriate was initiated in 20% and 9% of patients with noncardioembolic and cardioembolic stroke, respectively. Errors in appropriate prescribing of secondary prevention medications were related to statins and antihypertensives. Conclusion: Better adherence to preventative recurrent stroke measures is needed at the time of patient discharge.   Type: Student Project

2014 Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack

2017 ◽  
Vol 12 (3) ◽  
pp. 302-320 ◽  
Author(s):  
Yongjun Wang ◽  
Ming Liu ◽  
Chuanqiang Pu
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Evidence Based ◽  
Cerebrovascular Disorder ◽  
Level Of Evidence ◽  
Vascular Stenosis ◽  
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.

scholarly journals Cerebral Microbleeds and Early Recurrent Stroke After Transient Ischemic Attack

2015 ◽  
Vol 72 (3) ◽  
pp. 301 ◽  
Author(s):  
Jae-Sung Lim ◽  
Keun-Sik Hong ◽  
Gyeong-Moon Kim ◽  
Oh Young Bang ◽  
Hee-Joon Bae ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Cerebral Microbleeds ◽  
Ischemic Attack

Abstract WP359: Microembolic Signals Are Associated With Stroke Readmission in Patients With Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Nasir Fakhri ◽  
Simin Mahinrad ◽  
Arth Srivastava ◽  
Eric Liotta ◽  
Richard Bernstein ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Recurrent Stroke ◽  
Incidence Rates ◽  
High Risk Population ◽  
Stroke Patients ◽  
Entire Cohort ◽  
Cox Proportional Hazard ◽  
Stroke Population ◽  
Cox Proportional Hazard Models ◽  
Ischemic Attack

Background: Microembolic signals (MES) identified by transcranial Doppler (TCD) are strong predictors of recurrent stroke in patients with carotid disease. In this study, we investigated the association of MES with transient ischemic attack (TIA) or stroke readmission among ischemic stroke patients. Methods: We included a total of 789 patients (mean age 62±17 years, 55% male) who were consecutively admitted to Northwestern Memorial hospital with a diagnosis of stroke. All patients who underwent TCD studies within the first 48 hours of admission were included. Using an electronic database warehouse, patients were followed during 12 months for any hospital readmission due to ischemic stroke or TIA. Risk of stroke readmission was estimated using multivariate Cox proportional hazard models. Results: MES were detected in 95 patients on admission. During 12 months of follow-up, incidence rates for stroke and TIA readmission, and stroke readmission alone were 23.0 and 7.0 per 100 person-years across the entire cohort, respectively. In multivariate adjusted models, patients with MES, as compared to patients without MES, had 1.80-fold (95% CI=1.07, 2.53; p =0.008) higher risk of stroke and TIA readmission, and 2.30-fold (95% CI=1.13, 4.67, p =0.021) higher risk of readmission due to stroke alone. Conclusion: We showed that the presence of MES early after stroke admission is associated with higher risk of stroke and TIA readmission in stroke patients. This not only highlights the importance of identifying MES in the stroke population upon first admission, but also the need to further identify and implement therapeutic strategies to reduce stroke burden and prevent readmission in this high-risk population.

Abstract 17352: Differences in Clinical Characteristics, Risk Factors, Rate of Recurrence and 1-year Outcome Between Acute Heart Failure Patients With Stroke or TIA and Those Without This Co-morbidity. Results From the Gulf aCute heArt failuRe rEgistry (gulf Care)

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Mohammed A Al Hashemi ◽  
Kadhim Sulaiman ◽  
Jassim Al-Suwaidi ◽  
Khalid F AlHabib ◽  
Husam AlFaleh ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Clinical Characteristics ◽  
De Novo ◽  
Stroke Patients ◽  
Lv Dysfunction ◽  
Co Morbidity ◽  
History Of ◽  
One Year ◽  
Ischemic Attack

Background: Chronic heart failure (CHF) is a known risk for stroke and morbidities and mortalities are known to be higher in CHF patients compared to stroke patients without CHF we here study the prevalence and the clinical significance in a group of patient with stroke or transient ischemic attack (TIA) who were admitted to hospital with acute heart failure (AHF) compared to those without stroke and are admitted with acute heart failure Methods: Data were derived from a prospective, multicenter, multinational study of 5005 patients hospitalized with AHF from February 2013 to November 2012. Data were analyzed according to the presence or absence of Stroke or bronchial TIA. Demographic, management, in-hospital and 1-year outcomes were compared Results: Stroke patients were likely to have a decompensation of chronic failure rather than De-Novo AHF when compared to those without Stroke/TIA (see table). Stroke patients were older; more likely to be female, have history of DM, HTN, dyslipidemia and CKD. Stroke patients were likely to have Atrial fibrillation, PVD, systolic LV dysfunction as well as CAD when compared to those without Stroke, they were also more likely receive NIV, IV inotropes and likely to have had cardiac PCI prior to this admission with AHF. Stroke patients had higher recurrence of stroke and one-year mortality rates. Conclusion: Patients who presented with AHF and history of stroke/TIA were having different clinical characteristics as well as comorbidities as compared to those without Stroke, with worse in-hospital and one-year outcome. The current study underlies the need to aggressively manage these high-risk patients.

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