scholarly journals Carotid Stenosis and Recurrent Ischemic Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Shadi Yaghi ◽  
Adam de Havenon ◽  
Sara Rostanski ◽  
Alexandra Kvernland ◽  
Brian Mac Grory ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
High Risk ◽  
Carotid Stenosis ◽  
Transient Ischemic Attack ◽  
Stroke Risk ◽  
Hazard Ratio ◽  
Minor Ischemic Stroke ◽  
Increased Risk ◽  
Ischemic Stroke Risk ◽  
Ischemic Attack

Background and Purpose: Randomized trials demonstrated the benefit of dual antiplatelet therapy in patients with minor ischemic stroke or high-risk transient ischemic attack. We sought to determine whether the presence of carotid stenosis was associated with increased risk of ischemic stroke and whether the addition of clopidogrel to aspirin was associated with more benefit in patients with versus without carotid stenosis. Methods: This is a post-hoc analysis of the POINT trial (Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke) that randomized patients with minor ischemic stroke or high-risk transient ischemic attack within 12 hours from last known normal to receive either clopidogrel plus aspirin or aspirin alone. The primary predictor was the presence of ≥50% stenosis in either cervical internal carotid artery. The primary outcome was ischemic stroke. We built Cox regression models to determine the association between carotid stenosis and ischemic stroke and whether the effect of clopidogrel was modified by ≥50% carotid stenosis. Results: Among 4881 patients enrolled POINT, 3941 patients met the inclusion criteria. In adjusted models, ≥50% carotid stenosis was associated with ischemic stroke risk (hazard ratio, 2.45 [95% CI, 1.68–3.57], P <0.001). The effect of clopidogrel (versus placebo) on ischemic stroke risk was not significantly different in patients with <50% carotid stenosis (adjusted hazard ratio, 0.68 [95% CI, 0.50–0.93], P =0.014) versus those with ≥50% carotid stenosis (adjusted hazard ratio, 0.88 [95% CI, 0.45–1.72], P =0.703), P value for interaction=0.573. Conclusions: The presence of carotid stenosis was associated with increased risk of ischemic stroke during follow-up. The effect of added clopidogrel was not significantly different in patients with versus without carotid stenosis. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03354429.

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.

scholarly journals Impaired Glucose Tolerance Increases Stroke Risk in Nondiabetic Patients With Transient Ischemic Attack or Minor Ischemic Stroke

Stroke ◽  
2006 ◽  
Vol 37 (6) ◽  
pp. 1413-1417 ◽  
Author(s):  
Sarah E. Vermeer ◽  
Willemijn Sandee ◽  
Ale Algra ◽  
Peter J. Koudstaal ◽  
L. Jaap Kappelle ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Transient Ischemic Attack ◽  
Stroke Risk ◽  
Minor Ischemic Stroke ◽  
Ischemic Attack

scholarly journals Validation of the ABCD 2 Score to Identify the Patients With High Risk of Late Stroke After a Transient Ischemic Attack or Minor Ischemic Stroke

Stroke ◽  
2010 ◽  
Vol 41 (6) ◽  
pp. 1298-1300 ◽  
Author(s):  
Jie Yang ◽  
Jian-Hui Fu ◽  
Xiang-Yan Chen ◽  
Yang-Kun Chen ◽  
Thomas W. Leung ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
High Risk ◽  
Transient Ischemic Attack ◽  
Minor Ischemic Stroke ◽  
Ischemic Attack

scholarly journals Prediction of stroke risk in patients with transient ischemic attack: ABCD score and its derived scores

2017 ◽  
Vol 5 (12) ◽  
pp. 5093
Author(s):  
Wu Xin-Tong ◽  
Chen Jin-Bo ◽  
Xu Wen-Xiang ◽  
Lu Wen-Xian
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Ischemic Stroke ◽  
High Risk ◽  
Transient Ischemic Attack ◽  
Predictive Value ◽  
Stroke Risk ◽  
Ischemic Cerebrovascular Disease ◽  
Ischemic Attack ◽  
Abcd Score

Transient Ischemic Attack (TIA) is a high-risk signal of acute ischemic cerebrovascular disease, indicates a significant increase in the risk of ischemic stroke, especially within 7 days. Risk assessment and stratification are important in patient with TIA. A variety of simple prediction scales were developed based on the risk factors for stroke in patients with TIA, such as the California scale, ABCD scale, and ABCD2 scale. Among them, the ABCD scale score is used most commonly, but as its application becomes more and more common, the defects of this scale are also increasingly apparent. In recent years, some derived scales of ABCD score were introduced in order to improve the sensitivity and specificity of prediction. This article reviews the evolution, contents, characteristics, and predictive value of the ABCD score and its derived scales in the prediction of the stroke risk in patients with TIA.

scholarly journals Quality of Care and Ischemic Stroke Risk After Hospitalization for Transient Ischemic Attack

2015 ◽  
Vol 8 (6 suppl 3) ◽  
pp. S117-S124 ◽  
Author(s):  
Emily C. O’Brien ◽  
Xin Zhao ◽  
Gregg C. Fonarow ◽  
Phillip J. Schulte ◽  
David Dai ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Quality Of Care ◽  
Transient Ischemic Attack ◽  
Stroke Risk ◽  
Ischemic Stroke Risk ◽  
Ischemic Attack

scholarly journals Polymorphisms in Inflammatory Genes and the Risk of Ischemic Stroke and Transient Ischemic Attack: Results of a Multilocus Genotyping Assay

2009 ◽  
Vol 55 (1) ◽  
pp. 134-138 ◽  
Author(s):  
Stefan Greisenegger ◽  
Sonja Zehetmayer ◽  
Peter Bauer ◽  
Georg Endler ◽  
Julia Ferrari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Genetic Variation ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Stroke Risk ◽  
Conditional Logistic Regression ◽  
Pcr Analysis ◽  
Increased Risk ◽  
Ischemic Attack

Abstract Background: Single-nucleotide polymorphisms (SNPs) in inflammation-related genes have been linked to an increased risk of ischemic stroke. Most of these SNP results have not been replicated, however, and metaanalyses of the effects of inflammation-related genes are rare. We investigated 49 SNPs in 34 genes previously reported to be related to inflammation in our study. We tested 459 patients with acute ischemic stroke or transient ischemic attack and 459 controls individually matched by sex and age. Methods: We studied genetic variation by PCR analysis and subsequent hybridization to linear arrays of sequence-specific oligonucleotides. We used univariate conditional logistic regression analysis to test for associations of conventional vascular risk factors and the SNPs with stroke. Variables showing significant differences (P &lt; 0.05) between cases and controls were included in a multivariate model. ROC curves were plotted to assess the contribution of genetic variation to stroke risk in addition to that of conventional risk factors. Results: Univariate regression analysis revealed 3 SNPs with significant allelic differences between patients and controls, which fulfilled the criteria for further analysis. Only one of these SNPs, the C5 (complement component 5) 2416A&gt;G variant (rs17611), remained significant after the multivariate analysis (odds ratio, 0.585; P = 0.0037). ROC curve analysis revealed no contribution of this genetic variation to stroke risk. Conclusions: We found evidence for an association of the 2416A&gt;G polymorphism in the C5 gene with the risk for ischemic stroke. Our data suggest that the C5 gene particularly influences the risk for patients with microangiopathy.

scholarly journals Ticagrelor vs Clopidogrel in addition to Aspirin in minor ischemic stroke/ transient ischemic attack—Protocol for a systematic review and network meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250553
Author(s):  
Gabriele Zitikyte ◽  
Danielle Carole Roy ◽  
Shan Dhaliwal ◽  
Ronda Lun ◽  
Brian Hutton ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
High Risk ◽  
Transient Ischemic Attack ◽  
Symptom Onset ◽  
Recurrent Stroke ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Minor Ischemic Stroke ◽  
Ischemic Attack

Introduction Patients with minor ischemic stroke or transient ischemic attack represent a high-risk population for recurrent stroke. No direct comparison exists comparing dual antiplatelet therapy regimens—namely, Ticagrelor and Aspirin versus Clopidogrel and Aspirin. This systematic review and network meta-analysis (NMA) will examine the efficacy of these two different antiplatelet regimens in preventing recurrent stroke and mortality up to 30 days. Methods and analysis MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) will be searched with the assistance of a medical information specialist. Two independent reviewers will screen studies for inclusion; eligible studies will include randomized controlled trials that enrolled adults presenting with acute minor ischemic stroke or transient ischemic attack and compared one or more of the interventions against each other and/or a control. The primary outcomes will be recurrent ischemic stroke up to 30 days from symptom onset. Secondary outcomes will include safety outcomes (I.e. major bleeding and mortality), functional disability, and outcomes up to 90 days from symptom onset. A Bayesian approach to NMA will be implemented using the BUGSnet function in R Software. Between group comparisons for time-to-event (TTE) and dichotomous outcomes will be presented in terms of hazard ratios and odds ratios with 95% credible intervals, respectively. Secondary effect measures of treatment ranking will also be estimated. Ethics and dissemination No formal research ethics approval are necessary. We will disseminate our findings through scientific conference presentations, peer-reviewed publications, and social media/the press. The findings from this review will aid clinicians in decision-making on the choice of antithrombotic therapy in a high-risk stroke population and could be important in the development of future treatment trials and guidelines. Registration ID with Open Science Framework: 10.17605/OSF.IO/XDJYZ.

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