Embolization of Cerebral Aneurysms with Spherically Shaped Detachable Microcoils (MicruSphere Microcoil System)

We present our initial experience of concentric-filling technique using MicruSphere 3D coils (Micrus Endovascular, San Jose, CA) in the treatment of intracranial aneurysms. 149 intracranial saccular aneurysms in 142 consecutive patients (mean age 56.6 ± 12.7, ruptured in 54 (36.2%)) were treated with the concentric-filling technique. The mean aneurysm volume was 169.0 ± 363.0 mm3. Neck remodeling technique was used in 120 (80.5%). Procedure-related problems were recorded. Initial embolization results were evaluated, and the coil packing density was calculated. Clinical and angiographic follow-ups were performed after six months. Any changes in embolization status were classified as ‘improved’, ‘unchanged’, or ‘worse’. The overall packing density was 40.1% (range 10.5–90.9%). The permanent morbidity and mortality rates were 4.0% and 1.3%, respectively. The initial Raymond and Roy classification results were class 1 in 37 aneurysms (24.8%), class 2 in 50 (33.6%), and class 3 in 62 (41.6%). On the mean follow-up examination of 8.2 months in 103 patients (72.5%), there were one transient ischemic attack, one minor stroke, and one instance of rebleeding. Angiographic follow-up in 101 aneurysms (67.8%) showed the change in embolization status as ‘improved’ in 42 aneurysms (41.6%), ‘unchanged’ in 42 (41.6%), and ‘worse’ in 17 (recanalisation rate, 16.8%). The concentric-filling technique using Micrusphere 3D coils was effective in achieving high packing density which in turn resulted in stable embolization in the majority of the aneurysms. Longer follow-up is warranted to determine the durability of these results.

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Abstract TP438: Japanese versus Non-Japanese Patients With Transient Ischemic Attack or Minor Stroke: Five-Year Risk of Stroke and Vascular Events

Stroke ◽

10.1161/str.51.suppl_1.tp438 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Shinichiro Uchiyama ◽

Takao Hoshino ◽

Hugo Charles ◽

Kenji Kamiyama ◽

Taizen Nakase ◽

...

Keyword(s):

Intracranial Hemorrhage ◽

Transient Ischemic Attack ◽

Japanese Patients ◽

Minor Stroke ◽

Stroke Recurrence ◽

Large Artery ◽

Vascular Events ◽

Minor Ischemic Stroke ◽

Ischemic Attack

Background: We have reported 5-year risk of stroke and vascular events after a transient ischemic attack (TIA) or minor ischemic stroke in patients enrolled into the TIAregistry.org, which was an international multicenter-cooperative, prospective registry (N Engl J Med 2018;378:2182-90). We conducted subanalysis on the 5-year follow-up data of Japanese patients in comparison with non-Japanese patients. Methods: The patients were classified into two groups on ethnicity, Japanese (n=345) and non-Japanese (n=3502), and their 5-year event rates were compared. We also determined predictors of five-year stroke in both groups. Results: Death from vascular cause (0.9% vs 2.7%, HR 0.28, 95% CI 0.09-0.89, p=0.031) and death from any cause (7.8% vs 9.9%, HR 0.67, 95% CI 0.45-0.99, p=0.045) were fewer in Japanese patients than in non-Japanese patients, while stroke (13.9% vs 7.2%, HR 1.78, 95% CI 1.31-2.43, p<0.001) and intracranial hemorrhage (3.2% vs 0.8%, HR 3.61. 95% CI 1.78-7.30, p<0.001) were more common in Japanese than non-Japanese patients during five-year follow-up period. Caplan-Meyer curves at five-years showed that the rates of stroke was also significantly higher in Japanese than non-Japanese patients (log-rank test, p=0.001). Predictors for stroke recurrence at five years were large artery atherosclerosis (HR 1.81, 95% CI 1.31-2.52, p<0.001), cardioembolism (HR 1.71, 95% CI 1.18-2.47, p=0.004), multiple acute infarction (HR 1.77, 95% CI 1.27-2.45, p<0.001) and ABCD 2 score 6 or 7 (HR 1.96, 95% CI 1.38-2.78, p<0.001) in non-Japanese patients, although only large artery atherosclerosis (HR 3.28, 95% CI 1.13-9.54, p=0.029) was a predictor for stroke recurrence in Japanese patients. Conclusions: Recurrence of stroke and intracranial hemorrhage were more prevalent in Japanese than non-Japanese patients. Large artery atherosclerosis was a predictor for stroke recurrence not only in non-Japanese patients but also in Japanese patients.

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Abstract P187: When A Global Crisis Closes Your Clinic: A Telemedicine Approach for Transient Ischemic Attack and Minor Stroke Care During the Covid-19 Pandemic

Stroke ◽

10.1161/str.52.suppl_1.p187 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Rachelle Dugue ◽

Joshua Z Willey ◽

Eliza C Miller ◽

Ian M Kronish ◽

Bernard P Chang

Keyword(s):

New York ◽

Secondary Prevention ◽

Retrospective Chart Review ◽

Stroke Care ◽

Medical Intervention ◽

Minor Stroke ◽

Ischemic Attack ◽

Peripheral Vertigo ◽

Patient Infection

Introduction: Recent work has demonstrated the safety and feasibility of rapid outpatient evaluation for presentations of TIA and non-disabling stroke. Our outpatient TIA and stroke clinic, Rapid Access Vascular Evaluation-Neurology (RAVEN) clinic, instituted in 2016, encountered unprecedented challenges in operations during the COVID-19 surge in New York City, leading to the creation of a telemedicine approach to minimize patient and staff exposure risk. To date, few virtual TIA/stroke clinics have reported on safety and feasibility outcomes. Hypothesis: We hypothesized that rapid follow-up of patients with suspected TIA and minor stroke via telemedicine would be feasible and safe during the pandemic. Methods/Results: We performed a retrospective chart review of patients with TIA and minor stroke who were referred to the virtual clinic from the emergency department (ED) between March and June 2020 (the local peak of the COVID-19 pandemic) when RAVEN in-person visits were suspended. A total of 24 patients were discharged early from the ED and referred for RAVEN evaluation with 20 patients evaluated as scheduled; 4 were lost to RAVEN follow-up. Ultimately, 60% of these patients were diagnosed with TIA or minor stroke after completing their remote evaluation; the rest were diagnosed as stroke mimics (seizure, migraine with aura, neuropathy, peripheral vertigo, stroke recrudescence). The median NIHSS calculated at initial ED evaluation was 1 with a maximum NIHSS of 5. A new medical intervention for secondary prevention was prescribed for 70% of patients prior to ED discharge. Amongst patients contacted by phone 3-5 months post-RAVEN evaluation, 4 of 15 had an increased modified Rankin score. Of the 24 patients referred for RAVEN evaluation, 7 returned to the ED within 90 days, with 3 patients citing neurologic complaints. On follow-up via phone conducted 2-5 months after RAVEN evaluation, 3 of 17 patients self-reported either a positive COVID-19 test or suspected COVID-19 diagnosis over the study period. Conclusion: A telemedicine-based approach to evaluate TIA and stroke in the RAVEN model helped limit patient infection risk, optimize resource allocation, establish accurate, timely diagnoses, and effectively implement secondary prevention strategies.

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Endovascular treatment of ruptured aneurysms in anterior cerebral circulation with double microcatheter technique

10.21203/rs.3.rs-16408/v1 ◽

2020 ◽

Author(s):

Xintong Zhao ◽

Jiaqiang Liu ◽

Huifang Wang ◽

Zihuan Zhang ◽

Zhenbao Li

Keyword(s):

Risk Factors ◽

Optimal Strategy ◽

Cerebral Circulation ◽

Cerebral Aneurysms ◽

Partial Occlusion ◽

Ruptured Aneurysms ◽

Permanent Morbidity ◽

Clinical Records ◽

Related Mortality

Abstract Purpose Single coiling may be the optimal strategy for ruptured aneurysms. But assisted techniques may be needed in some aneurysms. The authors report their experience of double microcatheter technique in the treatment of ruptured aneurysms in anterior cerebral circulation. Methods Between 2012 and 2018, 82 patients with ruptured aneurysms in anterior cerebral circulation were treated with double microcatheter technique. The clinical records, angiographic results, procedure-related complications were reviewed. Clinical and angiographic follow-up was performed. Results Completely occlusion, neck remnant and partial occlusion were achieved in 56.6%, 36.1% and 7.2% in the whole procedures, respectively. The overall rate of morbidity was 8.5% (7/82). The rate of permanent morbidity was 3.7% (3/82). Three patients (3.7%) died before discharge. There was no procedure-related mortality. The favorable outcomes were obtained in 75.6% (62/82) of the whole patients at discharge. High Hunt-Hess grade and suffering from craniotomy or EVD were risk factors for clinical outcomes at discharge. Sixty-eight patients received clinical follow-up at a mean interval of 15.75±12.71 months. Favorable outcomes were obtained in 61 (89.7%) patients. Angiographic follow-up was performed in 44 patients at an average of 13.16±13.12 months. The recurrence rate is 34.1%. Seven of them (15.9%) received retreatment. Conclusion Double microcatheter technique is a safe and effective method for treatment of ruptured aneurysms in anterior cerebral aneurysms with low morbidity. Recurrence remains a problem. Patients should be followed up regularly.

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Stent-assisted coiling of cerebral aneurysms with the Neuroform Atlas stent

Interventional Neuroradiology ◽

10.1177/1591019917753710 ◽

2018 ◽

Vol 24 (3) ◽

pp. 263-269 ◽

Cited By ~ 25

Author(s):

Ferdi Cay ◽

Ahmet Peker ◽

Anıl Arat

Keyword(s):

Cerebral Aneurysms ◽

Minor Stroke ◽

Parent Artery ◽

Technical Success ◽

Technical Success Rate ◽

Patient Demographics ◽

Clinical Events ◽

Angular Change ◽

A Minor

Objectives The Neuroform Atlas stent (AS) is the smallest intracranial stent with an open-cell design. This study reports the first clinical experience with AS. Methods All intracranial aneurysms treated by stent-assisted coiling using a single AS in a single institution were retrospectively evaluated. Patient demographics, aneurysm characteristics, angles between the parent artery and stented branch, technical success, and clinical and angiographic follow-up were analyzed. Results Fifty-five consecutive aneurysms treated with AS-assisted coiling were included. Of these, 69.1% were located distal to the circle of Willis. Technical success rate was 100%. The mean diameters of proximal and distal parent arteries were 2.62 mm (range 1.5–4.4) and 1.8 mm (range 0.8–3.5), respectively. Except for a minor stroke in a patient who completely discontinued antiplatelet therapy on postoperative day 4, there were no clinical events with permanent sequelae, and 94.1% of patients had Raymond-Roy score of 1 or 2 aneurysmal occlusion at a mean follow-up duration of 7.9 months. Although the angle between the parent artery and the stented branch increased significantly ( p < 0.001) with time, the angular change at follow-up was only 16.45 ± 11.03 degrees and was inversely correlated both with preoperative angle and the diameter of the distal parent artery ( r = −0.465 and r = −0.433, respectively, p = 0.004 for both). Conclusion AS-assisted coiling was associated with a favorable early clinical outcome and angiographic results in this series. This stent can be used for distally located aneurysms and results in minimal alteration of the arterial anatomy.

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INTRACRANIAL ELECTROENCEPHALOGRAPHY WITH SUBDURAL GRID ELECTRODES

Neurosurgery ◽

10.1227/01.neu.0000324996.37228.f8 ◽

2008 ◽

Vol 63 (3) ◽

pp. 498-506 ◽

Cited By ~ 109

Author(s):

Jamie J. Van Gompel ◽

Gregory A. Worrell ◽

Michael L. Bell ◽

Todd A. Patrick ◽

Gregory D. Cascino ◽

...

Keyword(s):

Diagnostic Technique ◽

Partial Epilepsy ◽

High Yield ◽

Epileptogenic Zone ◽

Grid Monitoring ◽

Permanent Morbidity ◽

The Mean ◽

Intracranial Electroencephalography ◽

Intracranial Recordings

ABSTRACT OBJECTIVE Intracranial subdural grid monitoring is a useful diagnostic technique for surgical localization in patients with intractable partial epilepsy. The rationale for the present study was to assess the morbidity of intracranial recordings and the surgical outcomes. METHODS We retrospectively reviewed the clinical data for 189 unique patients undergoing 198 intracranial subdural grid monitoring sessions between 1996 and 2004 at a tertiary epilepsy center. RESULTS The mean age of patients undergoing monitoring was 28 ± 14 years. An average of 63 ± 23 electrodes were inserted. The mean duration of monitoring was 8 ± 4 days. Localization of an epileptogenic zone occurred in 156 sessions (79%) resulting in 136 resections (69%). There were 13 major complications (6.6%), including five infections and six hematomas. Three patients (1.5%) developed permanent deficits related to implantation. Sixty-two (47%) of 136 patients undergoing resection were seizure-free after resection. An additional 38 patients (28%) had a significant reduction in seizures. The mean follow-up was 51 ± 30 months. The duration of monitoring, bone flap replacement, number of electrodes, and perioperative corticosteroids were not associated with infection or complication. CONCLUSION Subdural grid monitoring for identification an epileptogenic focus is high yield, revealing a focus in 79% of monitoring sessions. Complications rarely result in permanent morbidity (1.5%). Surgical outcome indicated that 74% of patients experienced a favorable reduction in seizure tendency.

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Microsurgical clipping of the anterior circulation aneurysms

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v20i4.1001 ◽

2018 ◽

Vol 20 (4) ◽

pp. 409-414

Author(s):

Carlos Eduardo Da Silva ◽

Paulo Eduardo Peixoto De Freitas ◽

Alicia Del Carmen Becerra Romero ◽

Fáberson João Mocelin Oliveira ◽

Márcio Aloisio Bezerra Cavalcanti Rockenbach ◽

...

Keyword(s):

Relevant Literature ◽

Cerebral Aneurysms ◽

Series Data ◽

Anterior Communicating Artery ◽

Anterior Circulation ◽

Ruptured Aneurysms ◽

Microsurgical Clipping ◽

The Mean ◽

Anterior Circulation Aneurysms

Introduction: The authors present the analysis of the microsurgical clipping of 100 cerebral aneurysms of the anterior circulation and compare the series data with the literature. Methods: Eighty-eight patients presenting with 100 anterior circulation aneurysms operated on microsurgical techniques between 2002 and 2008 by the first author (CES) were retrospectively reviewed. Results: A total of 88 patients with 100 aneurysms of the anterior circulation were treated in a six years period. Fifty eight female (66%) and thirty male (34%) with nine patients (10.2%) presenting with multiple aneurysms. The mean age was 52 years (range from 26 to 76 years). Eighty five percent of the cases were ruptured aneurysms. The mean follow-up was 52.4 months (range from 5 to 76 months). The topography of the aneurysms was distributed as it follows: Anterior communicating artery (ACoA) 25%; posterior communicating artery (p-comm) 29%; middle cerebral artery (MCA) 27%; paraclinoidal aneurysms 8%; pericallosal artery 6% and internal carotid artery (ICA) tip 5%. The mortality was 7.9%, and such cases presenting with Hunt Hess graduation 3 and 4. The permanent morbidity was 4.5%, cases with Hunt Hess graduation 3 and 4. Perioperative rupture occurred in 17% of the cases, only in previous ruptured aneurysms. There was no clinical evidence of rebleeding during the follow-up period of the series. Conclusions: The microsurgical clipping of cerebral aneurysms of the anterior circulation is a safe and curative treatment for most of such lesions. At present, studies suggest evidences of superior results of surgery compared to the endovascular techniques in the rates of total occlusion of the aneurysms, lesser rates of rebleeding of the treated cases. The results of the present series are similar to the rates of the most relevant literature.

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Flow diversion of tandem cerebral aneurysms: a multi-institutional retrospective study

Neurosurgical FOCUS ◽

10.3171/2017.2.focus1731 ◽

2017 ◽

Vol 42 (6) ◽

pp. E10 ◽

Cited By ~ 4

Author(s):

Al-Wala Awad ◽

Karam Moon ◽

Nam Yoon ◽

Marcus D. Mazur ◽

M. Yashar S. Kalani ◽

...

Keyword(s):

Salt Lake ◽

Demographic Data ◽

Salt Lake City ◽

Cerebral Aneurysms ◽

Flow Diversion ◽

Single Session ◽

Anterior Circulation ◽

The Mean ◽

Lake City

OBJECTIVEFlow diversion has proven to be an efficacious means of treating cerebral aneurysms that are refractory to other therapeutic means. Patients with tandem aneurysms treated with flow diversion have been included in larger, previously reported series; however, there are no dedicated reports on using this technique during a single session to treat this unique subset of patients. Therefore, the authors analyzed the outcomes of patients who had undergone single-session flow diversion for the treatment of tandem aneurysms.METHODSThe authors conducted a retrospective review of flow diversion with the Pipeline embolization device (PED) for the treatment of tandem aneurysms in a single session at 2 participating medical centers: University of Utah, Salt Lake City, Utah, and Barrow Neurological Institute, Phoenix, Arizona. Patient demographic data, aneurysm characteristics, treatment strategy and results, complications, and follow-up data were collected from the medical record and analyzed.RESULTSBetween January 2011 and December 2015, 17 patients (12 female, 5 male) with a total of 38 aneurysms (mean size 4.7 ± 2.7 mm, mean ± SD) were treated. Sixteen patients had aneurysms in the anterior circulation, and 1 patient had tandem aneurysms in the posterior circulation. Twelve patients underwent only placement of a PED, whereas 5 underwent adjunctive coil embolization of at least 1 aneurysm. One PED was used in each of 9 patients, and 2 PEDs were required in each of 8 patients. There were 2 intraprocedural complications; however, in both instances, the patients were asymptomatic at the last follow-up. The follow-up imaging studies were available for 15 patients at a mean of 7 months after treatment (216 days, range 0–540 days). The mean initial Raymond score after treatment was 2.7 ± 0.7, and the mean final score was 1.3 ± 0.7.CONCLUSIONSIn this series, the use of flow diversion for the treatment of tandem cerebral aneurysms had an acceptable safety profile, indicating that it should be considered as an effective therapy for this complicated subset of patients. Further prospective studies must be performed before more definitive conclusions can be made.

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Endovascular coiling of small intracranial aneurysms using a very soft bare platinum coil: A comparison of the packing performance of new and old HyperSoft® helical coils

Interventional Neuroradiology ◽

10.1177/1591019915617319 ◽

2015 ◽

Vol 22 (1) ◽

pp. 26-33 ◽

Cited By ~ 1

Author(s):

Hecheng Ren ◽

Ming Wei ◽

Long Yin ◽

Lin Ma ◽

Longfeng Peng

Keyword(s):

Packing Density ◽

Cerebral Aneurysms ◽

Matched Pair ◽

Endovascular Coiling ◽

Control Group ◽

Helical Coil ◽

Platinum Coil ◽

Helical Coils ◽

The Mean ◽

Small Aneurysms

Aims Soft and small coils are known to be appropriate for the treatment of small aneurysms. The purpose of this study was to determine whether the new HyperSoft® helical coil, which is softer and smaller than its predecessors, has any effect on the packing performance in a matched-pair study with an old HyperSoft® helical coil. Materials and methods Thirty-six consecutive patients harboring 43 cerebral aneurysms treated with new HyperSofts were included in this study. Forty-one aneurysms treated with old HyperSofts were identified from our database as matched controls based on similar volumes and locations. Packing attenuation, adverse events during the procedures, and angiographic occlusions were observed and compared between the two groups. Results The mean packing density was significantly higher in the new HyperSoft® group compared to the control group (35.5% vs. 26.9%), and a larger proportion of the aneurysms embolized with the 1.5 mm size coil, which has higher packing density. There was no difference in immediate and midterm angiographic outcomes. There was no difference in the rate of intraprocedural perforation, but there was no intraprocedural rupture related to the 1.5 mm coil. Conclusions The use of new HyperSoft® helical coils allows higher packing density comparable with the old technology. New HyperSoft® coils, especially those with 1.5 mm loop diameter, can be expected to fill smaller residual spaces in small aneurysms and may be helpful in preventing recanalization.

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Four-Year Follow-Up of Transient Ischemic Attacks, Strokes, and Mimics

Stroke ◽

10.1161/strokeaha.114.008632 ◽

2015 ◽

Vol 46 (5) ◽

pp. 1227-1232 ◽

Cited By ~ 25

Author(s):

Dipankar Dutta ◽

Emily Bowen ◽

Chris Foy

Keyword(s):

Myocardial Infarction ◽

Hazard Ratio ◽

Vascular Event ◽

Minor Stroke ◽

Limited Information ◽

Stroke Incidence ◽

Rapid Access ◽

Assessment Time ◽

Ischemic Attack

Background and Purpose— There is limited information on outcomes from rapid access transient ischemic attack (TIA) clinics. We present 4-year outcomes of TIAs, strokes, and mimics from a UK TIA clinic database. Methods— All patients referred between April 2010 and May 2012 were retrospectively identified and outcomes determined. End points were stroke, myocardial infarction, any vascular event (TIA, stroke, or myocardial infarction), and all-cause death. Data were analyzed by survival analysis. Results— Of 1067 patients, 31.6% were TIAs, 18% strokes, and 50.4% mimics. Median assessment time was 4.5 days from onset and follow-up was for 34.9 months. Subsequent strokes occurred in 7.1% of patients with TIA, 10.9% of patients with stroke, and 2.0% of mimics at the end of follow-up. Stroke risk at 90 days was 1.3% for patients diagnosed as TIA or stroke. Compared with mimics, hazard ratios for subsequent stroke were 3.88 (1.90–7.91) for TIA and 5.84 (2.81–12.11) for stroke. Hazard ratio for any subsequent vascular event was 2.91 (1.97–4.30) for TIA and 2.83 (1.81–4.41) for stroke. Hazard ratio for death was 1.68 (1.10–2.56) for TIA and 2.19 (1.38–3.46) for stroke. Conclusions— Our results show a lower 90-day stroke incidence after TIA or minor stroke than in earlier studies, suggesting that rapid access daily TIA clinics may be having a significant effect on reducing strokes.

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Long-Term Impact of Urgent Secondary Prevention After Transient Ischemic Attack and Minor Stroke: Ten-Year Follow-Up of the EXPRESS Study

Stroke ◽

10.1161/strokeaha.121.034279 ◽

2021 ◽

Author(s):

Ramon Luengo-Fernandez ◽

Linxin Li ◽

Louise Silver ◽

Sergei Gutnikov ◽

Nicola C. Beddows ◽

...

Keyword(s):

Transient Ischemic Attack ◽

Stroke Risk ◽

Recurrent Stroke ◽

Hazard Ratio ◽

Minor Stroke ◽

Phase 2 ◽

Short Term ◽

Ischemic Attack

Background and Purpose: Urgent assessment aimed at reducing stroke risk after transient ischemic attack or minor stroke is cost-effective over the short-term. However, it is unclear if the short-term impact is lost on long-term follow-up, with recurrent events being delayed rather than prevented. By 10-year follow-up of the EXPRESS study (Early Use of Existing Preventive Strategies for Stroke), previously showing urgent assessment reduced 90-day stroke risk by 80%, we determined whether that early benefit was still evident long-term for stroke risk, disability, and costs. Methods: EXPRESS was a prospective population-based before (phase 1: April 2002–September 2004; n=310) versus after (phase 2: October 2004–March 2007; n=281) study of the effect of early assessment and treatment of transient ischemic attack/minor stroke on early recurrent stroke risk, with an external control. This report assesses the effect on 10-year recurrent stroke risk, functional outcomes, quality-of-life, and costs. Results: A reduction in stroke risk in phase 2 was still evident at 10 years (55/23.3% versus 82/31.6%; hazard ratio=0.68 [95% CI, 0.48–0.95]; P =0.024), as was the impact on risk of disabling or fatal stroke (17/7.7% versus 32/13.1%; hazard ratio=0.54 [0.30–0.97]; P =0.036). These effects were due to maintenance of the early reduction in stroke risk, with neither additional benefit nor rebound catch-up after 90 days (post-90 days hazard ratio=0.88 [0.65–1.44], P =0.88; and hazard ratio=0.83 [0.42–1.65], P =0.59, respectively). Disability-free life expectancy was 0.59 (0.03–1.15; P =0.043) years higher in patients in phase 2, as was quality-adjusted life expectancy (0.49 [0.03–0.95]; P =0.036). Overall, 10-year costs were nonsignificantly higher in patients attending the phase 2 clinic ($1022 [-3865–5907]; P =0.66). The additional cost per quality-adjusted life year gained in phase 2 versus phase 1 was $2103, well below current cost-effectiveness thresholds. Conclusions: Urgent assessment and treatment of patients with transient ischemic attack or minor stroke resulted in a long-term reduction in recurrent strokes and improved outcomes, with little atrophy of the early benefit over time, representing good value for money even with a 10-year time horizon. Our results suggest that other effective acute treatments in transient ischemic attack/minor stroke in the short-term will also have the potential to have long-term benefit.

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