Incidence, predictors, and etiology of subsequent ischemic stroke within one year after transient ischemic attack

Background Incidence and predictors of ischemic stroke in patients with transient ischemic attack (TIA) have not been fully clarified outside Europe and North America. Aims We undertook the present prospective, multicenter study to clarify the incidence, predictors, and etiology of ischemic stroke within one year of TIA onset in Japan. Methods The study subjects were patients within seven days of TIA onset who were enrolled in a prospective register from 57 hospitals between June 2011 and December 2013. The primary endpoint was occurrence of ischemic stroke. Results Of 1365 consecutive patients, 1245 were followed for one year after TIA onset; 101 (8.1%) experienced ischemic stroke during follow-up. The leading subtype of ischemic stroke was small-vessel occlusion (SVO) followed by large-artery atherosclerosis (LAA) attributable to intracranial artery diseases. When dividing ischemic stroke events between those occurring within the first 90 days after TIA onset and those occurring after the first 90 days, the leading subtype of ischemic stroke within the first 90 days after TIA onset was SVO, followed by LAA attributable to intracranial artery diseases. In comparison, the subtypes most commonly seen beyond the first 90 days after TIA onset were cardioembolic and LAA attributable to intracranial artery disease. The one-year risk of ischemic stroke increased significantly as ABCD2 score increased, at 6.2% for 0–3 points, 7.2% for 4–5 points, and 11.6% for 6–7 points. Conclusions The one-year ischemic stroke risk after TIA was about 8% and was associated with the ABCD2 score. The most common subtype of subsequent ischemic stroke was SVO.

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Clinical, Laboratory, and Imaging Characteristics of Transient Ischemic Attack Caused by Large Artery Lesions: A Comparison between Carotid and Intracranial Arteries

Cerebrovascular Diseases Extra ◽

10.1159/000440731 ◽

2015 ◽

Vol 5 (3) ◽

pp. 115-123 ◽

Cited By ~ 3

Author(s):

Toshiyuki Uehara ◽

Tomoyuki Ohara ◽

Kazunori Toyoda ◽

Kazuyuki Nagatsuka ◽

Kazuo Minematsu

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Transient Ischemic Attack ◽

Clinical Laboratory ◽

Stroke Care ◽

Large Artery ◽

Intracranial Artery ◽

Imaging Characteristics ◽

Artery Disease ◽

Ischemic Attack

Background/Aims: The aims of this study were to determine the differences in clinical characteristics and the risk of ischemic stroke between patients with transient ischemic attack (TIA) attributable to extracranial carotid and intracranial artery occlusive lesions. Methods: Among 445 patients admitted to our stroke care unit within 48 h of TIA onset between April 2008 and December 2013, 85 patients (63 men, mean age 69.4 years) with large artery occlusive lesions relevant to symptoms were included in this study. The primary endpoints were ischemic stroke at 2 and 90 days after TIA onset. Results: Twenty-eight patients had carotid artery occlusive lesions (extracranial group), and 57 patients had intracranial artery occlusive lesions (intracranial group). Patients in the intracranial group were significantly younger, had lower levels of fibrinogen, and were less likely to have occlusion when compared with those in the extracranial group. Eleven patients in the extracranial group and none in the intracranial group underwent revascularization procedures within 90 days of TIA onset. The 2-day risk (14.2 vs. 0%, p = 0.044) and the 90-day risk (17.1 vs. 0%, p = 0.020) of ischemic stroke after TIA onset were significantly higher in the intracranial group than in the extracranial group. Conclusions: Among our patients with TIA caused by large artery disease, patients with intracranial artery occlusive lesions were more frequent and were at higher risk of early ischemic stroke than those with extracranial carotid artery occlusive lesions. These data highlight the importance of prompt assessment of intracranial artery lesions in patients with TIA.

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Abstract WP136: Clinical, Laboratory, and Imaging Characteristics Oof Transient Ischemic Attack Caused by Large Artery Lesion: A Comparison Between Carotid and Intracranial Artery

Stroke ◽

10.1161/str.47.suppl_1.wp136 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Toshiyuki Uehara ◽

Tomoyuki Ohara ◽

Kazuyuki Nagatsuka ◽

Kazunori Toyoda ◽

Kazuo Minematsu

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Transient Ischemic Attack ◽

Clinical Laboratory ◽

Stroke Care ◽

Large Artery ◽

Intracranial Artery ◽

Imaging Characteristics ◽

Artery Disease ◽

Ischemic Attack

Background: The purpose of this study was to determine the differences in clinical characteristics and the risk of ischemic stroke between patients with transient ischemic attack (TIA) attributable to extracranial carotid and intracranial artery occlusive lesions. Methods: Among 445 patients admitted to our stroke care unit within 48 hours of TIA onset between April 2008 and December 2013, 85 patients (63 men, 69.4 years) with large artery occlusive lesions relevant to symptoms were included in this study. The primary endpoints were ischemic stroke at 2 days and 90 days after TIA onset. Results: Twenty-eight patients had carotid artery occlusive lesions (extracranial group), and 57 patients had intracranial artery occlusive lesions (intracranial group). Patients in the intracranial group were significantly younger, had lower levels of fibrinogen, and were less likely to have occlusion when compared to those in the extracranial group. Eleven patients in the extracranial group and no patient in the intracranial group underwent revascularization procedures within 90 days of TIA onset. The 2-day risk (14.2% vs. 0%, p = 0.044) and 90-day risk (17.1% vs. 0%, p = 0.020) of ischemic stroke after TIA onset were significantly higher in the intracranial group than in the extracranial group. Conclusions: Patients with intracranial artery occlusive lesions were more frequent and were at higher risk of early ischemic stroke than those with extracranial carotid artery occlusive lesions among our patients with TIA caused by large artery disease. These data highlight the importance of prompt assessment of intracranial artery lesions in patients with TIA.

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Coronary Artery Disease in Patients Presenting With Acute Ischemic Stroke or Transient Ischemic Attack and Elevated Troponin Levels

Frontiers in Neurology ◽

10.3389/fneur.2021.781553 ◽

2022 ◽

Vol 12 ◽

Author(s):

Mathieu Kruska ◽

Anna Kolb ◽

Christian Fastner ◽

Iris Mildenberger ◽

Svetlana Hetjens ◽

...

Keyword(s):

Coronary Artery Disease ◽

Ischemic Stroke ◽

Cardiovascular Risk ◽

Coronary Artery ◽

Transient Ischemic Attack ◽

Large Artery ◽

Elevated Troponin ◽

Stroke Patients ◽

Artery Disease ◽

Ischemic Attack

Background: There is little information concerning the invasive coronary angiography (ICA) findings of patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) with elevated troponin levels and suspected myocardial infarction (MI). This study analyzed patient characteristics associated with ICA outcomes.Methods: A total of 8,322 patients with AIS or TIA, treated between March 2010 and May 2020, were retrospectively screened for elevated serum troponin I at hospital admission. Patients in whom ICA was performed, due to suspected type 1 MI based on symptoms, echocardiography, and ECG, were categorized according to ICA results (non-obstructive coronary artery disease (CAD): ≥1 stenosis ≥50% but no stenosis ≥80%; obstructive CAD: any stenosis ≥80% or hemodynamically relevant stenosis assessed by FFR/iwFR).Results: Elevated troponin levels were detected in 2,205 (22.5%) patients, of whom 123 (5.6%) underwent ICA (mean age 71 ± 12 years; 67% male). CAD was present in 98 (80%) patients, of whom 51 (41%) were diagnosed with obstructive CAD. Thus, ICA findings of obstructive CAD accounted for 2.3% of patients with troponin elevation and 0.6% of all stroke patients. The clinical hallmarks of myocardial ischemia, including angina pectoris (31 vs. 15%, p < 0.05) and regional wall motion abnormalities (49 vs. 32%, p = 0.07), and increased cardiovascular risk indicated obstructive CAD. While there was no association between lesion site or stroke severity and ICA findings, causal large-artery atherosclerosis was significantly more common in patients with obstructive coronary disease (p < 0.05).Conclusion: The rate of obstructive CAD in patients with stroke or TIA and elevated troponin levels with suspected concomitant type I MI is low. The cumulation of several cardiovascular risk factors and clinical signs of MI were predictive. AIS patients with large-artery atherosclerosis and elevated troponin may represent an especially vulnerable subgroup of stroke patients with risk for obstructive CAD.

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EXPRESS: Evolving Ischemic Stroke Subtypes in 15 years: A hospital-based observational study

International Journal of Stroke ◽

10.1177/17474930211005953 ◽

2021 ◽

pp. 174749302110059

Author(s):

Yiu Ming Bonaventure Ip ◽

Lisa Au ◽

Yin Yan Anne Chan ◽

Florence Fan ◽

Hing Lung Ip ◽

...

Keyword(s):

Ischemic Stroke ◽

Recurrence Rate ◽

Small Vessel Disease ◽

Mainland China ◽

Cardioembolic Stroke ◽

Large Artery ◽

Risk Factor Control ◽

Stroke Subtypes ◽

Artery Disease ◽

Ischemic Attack

Background: Depicting the time trends of ischemic stroke subtypes may inform healthcare resource allocation on etiology-based stroke prevention and treatment. Aim: To reveal the evolving ischemic stroke subtypes from 2004 to 2018. Methods: We determined the stroke etiology of consecutive first-ever transient ischemic attack or ischemic stroke patients admitted to a regional hospital in Hong Kong from 2004 to 2018. We analyzed the age-standardized incidences and the 2-year recurrence rate of major ischemic stroke subtypes. Results: Among 6940 patients admitted from 2004 to 2018, age-standardized incidence of ischemic stroke declined from 187.0 to 127.4 per 100,000 population (p<0.001), driven by the decrease in large artery disease (43.0 to 9.67 per 100,000 population (p<0.001)) and small vessel disease (71.9 to 45.7 per 100,000 population (p<0.001)). Age-standardized incidence of cardioembolic stroke did not change significantly (p=0.2). Proportion of cardioembolic stroke increased from 20.4% in 2004-2006 to 29.3% in 2016-2018 (p<0.001). 2-year recurrence rate of intracranial atherothrombotic stroke reduced from 19.3% to 5.1% (p<0.001) with increased prescriptions of statin (p<0.001) and dual anti-platelet therapy (<0.001). In parallel with increased anticoagulation use across the study period (p<0.001), the 2-year recurrence of AF-related stroke reduced from 18.9% to 6% (p<0.001). Conclusion: Etiology-based risk factor control might have led to the diminishing stroke incidences related to atherosclerosis. To tackle the surge of AF-related strokes, arrhythmia screening, anticoagulation usage and mechanical thrombectomy service should be reinforced. Comparable preventive strategies might alleviate the enormous stroke burden in mainland China.

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Incidence and mortality of ischemic stroke subtypes in Joinville, Brazil: a population-based study

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20150081 ◽

2015 ◽

Vol 73 (8) ◽

pp. 648-654 ◽

Cited By ~ 8

Author(s):

Marcos C. Lange ◽

Norberto L. Cabral ◽

Carla H. C. Moro ◽

Alexandre L. Longo ◽

Anderson R. Gonçalves ◽

...

Keyword(s):

Ischemic Stroke ◽

Population Based ◽

Large Artery ◽

Vessel Occlusion ◽

Population Based Study ◽

Incidence And Mortality ◽

One Year ◽

Undetermined Etiology ◽

And Control ◽

Adjusted Incidence

Aims To measure the incidence and mortality rates of ischemic stroke (IS) subtypes in Joinville, Brazil. Methods All first-ever IS patients that occurred in Joinville from January 2005 to December 2006 were identified. The IS subtypes were classified by the TOAST criteria, and the patients were followed-up for one year after IS onset. Results The age-adjusted incidence per 100,000 inhabitants was 26 (17-39) for large-artery atherosclerosis (LAA), 17 (11-27) for cardioembolic (CE), 29 (20-41) for small vessel occlusion (SVO), 2 (0.6-7) for stroke of other determined etiology (OTH) and 30 (20-43) for stroke of undetermined etiology (UND). The 1-year mortality rate per 100,000 inhabitants was 5 (2-11) for LAA, 6 (3-13) for CE, 1 (0.1-6) for SVO, 0.2 (0-0.9) for OTH and 9 (4-17) for UND. Conclusion In the population of Joinville, the incidences of IS subtypes were similar to those found in other populations. These findings highlight the importance of better detection and control of atherosclerotic risk factors.

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Abstract WP49: Distal Hyperintense Vessels Were not a Predictor of Large Vessel Occlusion in Patients With Transient Ischemic Attack

Stroke ◽

10.1161/str.47.suppl_1.wp49 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Marcelo M de Figueiredo ◽

Marcela R Vazzoller ◽

Edson Amaro Jr ◽

Renata A Miranda ◽

Gisele S Silva

Keyword(s):

Transient Ischemic Attack ◽

Surrogate Marker ◽

Multivariate Logistic Regression Analysis ◽

Clinical Information ◽

Large Vessel ◽

Arterial Stenosis ◽

Large Artery ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Ischemic Attack

Introduction: Distal hyperintense vessels (DHV) detected by FLAIR imaging are not uncommon in patients with acute ischemic stroke. The presence of DHV and its predictors has been scarcely evaluated in patients with transient ischemic attack (TIA), being associated to the presence of large vessel occlusion in such patients. We assessed the hypothesis that DHV are frequent in patients with TIA and do correlate with relevant clinical and neuroimaging characteristics. Methods: We evaluated a database of consecutive patients admitted with TIA from February 2009 to June 2012 who had undergone magnetic resonance imaging within 30 h of symptoms onset and intracranial and extracranial vascular imaging. We analyzed the relationship between DHV, clinical presentation, risk factors, neuroimaging characteristics and large artery stenosis or occlusion. DHV signals were defined on FLAIR images as focal, linear or serpentine, hyperintense signals relative to gray matter. Two neuroradiologists blinded to clinical information reached consensus regarding the presence of DHV. Results: Seventy-two TIA patients were enrolled. The median time from symptoms onset to MRI was 8:39 h [4:21, 14:13]. DHV signals on FLAIR images were present in 12 (16.7 %) patients. The overall agreement between examiners was good (k 0.67). Patients with DHV had more atrial fibrillation (AF) than those without (41.7% versus 21.7%, p=0.05) and a trend towards more congestive heart failure (CHF) (8.3% versus 1.7%, p=0.2) and diabetes (41.7% versus 21.7%, p=0.1). There were no differences in the frequency of intracranial or cervical arterial stenosis, cerebral microbleeds and white matter abnormalities in patients with and without DHV. In a multivariate logistic regression analysis, only AF had a trend to be a predictor of DHV (OR=4.24, p=0.1). The statistical model to predict DHV including AF, diabetes, and CHF had a moderate fit in terms of discrimination (c statistic=0.62) Conclusion: DHV signals on FLAIR images occur in patients with TIA and might correlate with clinical variables like AF and not only with large vessel occlusion as previously described. The presence of DVH in patients with TIA and AF might be a surrogate marker for a previous large vessel occlusion spontaneously recanalized.

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Essen Risk Score in Prediction of Myocardial Infarction After Transient Ischemic Attack or Ischemic Stroke Without Prior Coronary Artery Disease

Stroke ◽

10.1161/strokeaha.119.025831 ◽

2019 ◽

Vol 50 (12) ◽

pp. 3393-3399 ◽

Cited By ~ 5

Author(s):

Marion Boulanger ◽

Linxin Li ◽

Shane Lyons ◽

Nicola G. Lovett ◽

Magdalena M. Kubiak ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Ischemic Stroke ◽

Coronary Artery ◽

Risk Score ◽

Transient Ischemic Attack ◽

Artery Disease ◽

Ischemic Attack

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

Cerebrovascular Diseases Extra ◽

10.1159/000450692 ◽

2016 ◽

Vol 6 (3) ◽

pp. 76-83 ◽

Cited By ~ 4

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.

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