Clinical Guideline for the Diagnostics and Treatment of Patients with Ischemic Stroke and Transitory Ischemic Attack – Version 2016

AbstractThis expert opinion paper on cardiac imaging after acute ischemic stroke or transient ischemic attack (TIA) includes a statement of the “Heart and Brain” consortium of the German Cardiac Society and the German Stroke Society. The Stroke Unit-Commission of the German Stroke Society and the German Atrial Fibrillation NETwork (AFNET) endorsed this paper. Cardiac imaging is a key component of etiological work-up after stroke. Enhanced echocardiographic tools, constantly improving cardiac computer tomography (CT) as well as cardiac magnetic resonance imaging (MRI) offer comprehensive non- or less-invasive cardiac evaluation at the expense of increased costs and/or radiation exposure. Certain imaging findings usually lead to a change in medical secondary stroke prevention or may influence medical treatment. However, there is no proof from a randomized controlled trial (RCT) that the choice of the imaging method influences the prognosis of stroke patients. Summarizing present knowledge, the German Heart and Brain consortium proposes an interdisciplinary, staged standard diagnostic scheme for the detection of risk factors of cardio-embolic stroke. This expert opinion paper aims to give practical advice to physicians who are involved in stroke care. In line with the nature of an expert opinion paper, labeling of classes of recommendations is not provided, since many statements are based on expert opinion, reported case series, and clinical experience.

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Molecular Analysis of Prothrombotic Gene Variants in Patients with Acute Ischemic Stroke and with Transient Ischemic Attack

Medicina ◽

10.3390/medicina57070723 ◽

2021 ◽

Vol 57 (7) ◽

pp. 723

Author(s):

Gustavo Cernera ◽

Marika Comegna ◽

Monica Gelzo ◽

Marcella Savoia ◽

Dario Bruzzese ◽

...

Keyword(s):

Ischemic Stroke ◽

Causes Of Death ◽

Southern Italy ◽

Large Population ◽

Mthfr C677t ◽

Geographic Area ◽

Gene Variants ◽

Interesting Possibility ◽

Ischemic Attack

Background and objectives: ischemic stroke (IS) is among the most frequent causes of death worldwide; thus, it is of paramount relevance to know predisposing factors that may help to identify and treat the high-risk subjects. Materials and Methods:we tested nine variants in genes involved in thrombotic pathway in 282 patients that experienced IS and 87 that had transient ischemic attacks (TIA) in comparison to 430 subjects from the general population (GP) of the same geographic area (southern Italy). We included cases of young and child IS to evaluate the eventual differences in the role of the analyzed variants. Results: we did not observe significant differences between TIA and the GP for any of the variants, while the allele frequencies of methylene-tetrahydrofolate reductase (MTHFR) C677T, beta-fibrinogen -455G>A and factor (FXIII) V34L were significantly higher in patients with IS than in the subjects from the GP. No significant interaction was observed with sex. Conclusions: the present data argue that some gene variants have a role in IS and this appears to be an interesting possibility to be pursued in large population studies to help design specific strategies for IS prevention.

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Risk factor control after ischemic stroke or transient ischemic attack

Acta Neurologica Scandinavica ◽

10.1111/ane.13398 ◽

2021 ◽

Author(s):

Nanxiang Ouyang ◽

Chuning Shi ◽

Xiaofan Guo ◽

Yihan Chen ◽

Yingxian Sun

Keyword(s):

Risk Factor ◽

Ischemic Stroke ◽

Transient Ischemic Attack ◽

Risk Factor Control ◽

Ischemic Attack

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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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DUAL ANTIPLATELET THERAPY IN ACUTE ISCHEMIC STROKE OR TRANSIENT ISCHEMIC ATTACK A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)03160-0 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1804

Author(s):

Giorgio Medranda ◽

Cheng Zhang ◽

Gheorghe Doros ◽

Charan Yerasi ◽

Brian Case ◽

...

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Randomized Controlled Trials ◽

Acute Ischemic Stroke ◽

Transient Ischemic Attack ◽

Dual Antiplatelet Therapy ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Ischemic Attack

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Value of Vascular and Non-Vascular Pattern on Computed Tomography Perfusion in Patients With Acute Isolated Aphasia

Stroke ◽

10.1161/strokeaha.120.028821 ◽

2020 ◽

Vol 51 (8) ◽

pp. 2480-2487

Author(s):

Salvatore Rudilosso ◽

Alejandro Rodríguez ◽

Sergio Amaro ◽

Víctor Obach ◽

Arturo Renú ◽

...

Keyword(s):

Computed Tomography ◽

Ischemic Stroke ◽

Clinical Outcome ◽

Predictive Value ◽

Brain Perfusion ◽

Complete Recovery ◽

Vascular Perfusion ◽

Computed Tomography Perfusion ◽

Stroke Mimic ◽

Ischemic Attack

Background and Purpose: Acute onset aphasia may be due to stroke but also to other causes, which are commonly referred to as stroke mimics. We hypothesized that, in patients with acute isolated aphasia, distinct brain perfusion patterns are related to the cause and the clinical outcome. Herein, we analyzed the prognostic yield and the diagnostic usefulness of computed tomography perfusion (CTP) in patients with acute isolated aphasia. Methods: From a single-center registry, we selected a cohort of 154 patients presenting with acute isolated aphasia who had a whole-brain CTP study available. We collected the main clinical and radiological data. We categorized brain perfusion studies on CTP into vascular and nonvascular perfusion patterns and the cause of aphasia as ischemic stroke, transient ischemic attack, stroke mimic, and undetermined cause. The primary clinical outcome was the persistence of aphasia at discharge. We analyzed the sensitivity, specificity, positive and negative predictive values of perfusion patterns to predict complete clinical recovery and ischemic stroke on follow-up imaging. Results: The cause of aphasia was an ischemic stroke in 58 patients (38%), transient ischemic attack in 3 (2%), stroke mimic in 68 (44%), and undetermined in 25 (16%). CTP showed vascular and nonvascular perfusion pattern in 62 (40%) and 92 (60%) patients, respectively. Overall, complete recovery occurred in 116 patients (75%). A nonvascular perfusion pattern predicted complete recovery (sensitivity 75.9%, specificity 89.5%, positive predictive value 95.7%, and negative predictive value 54.8%), and a vascular perfusion pattern was highly predictive of ischemic stroke (sensitivity 94.8%, specificity 92.7%, positive predictive value 88.7%, and negative predictive value 96.7%). The 3 patients with ischemic stroke without a vascular perfusion pattern fully recovered at discharge. Conclusions: CTP has prognostic value in the workup of patients with acute isolated aphasia. A nonvascular pattern is associated with higher odds of full recovery and may prompt the search for alternative causes of the symptoms.

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Adequate Platelet Function Inhibition Confirmed by Two Inductive Agents Predicts Lower Recurrence of Ischemic Stroke/Transient Ischemic Attack

BioMed Research International ◽

10.1155/2017/3504950 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Lulu Zhang ◽

Xiaowei Hu ◽

Juehua Zhu ◽

Xiuying Cai ◽

Yan Kong ◽

...

Keyword(s):

Ischemic Stroke ◽

Antiplatelet Therapy ◽

Platelet Function ◽

Adenosine Diphosphate ◽

Aggregation Rate ◽

Function Analyzer ◽

Ischemic Attack ◽

Platelet Function Analyzer ◽

Platelet Functions

Background. The correlation between platelet function and recurrent ischemic stroke or TIA remains uncertain. Objective. To investigate two inductive agents to detect platelet functions and assess associations with recurrent ischemic stroke/TIA. Method. The study included 738 ischemic stroke/TIA patients. On days 0, 3, and 9 after antiplatelet therapy, platelet function tests were determined by maximum aggregation rate (MAR) using a PL-11 platelet function analyzer and phase matching reagents. Two induction agents were used: arachidonic acid (AA) and adenosine diphosphate (ADP). At 3-month follow-up, recurrence of stroke/TIA was recorded. Result. Cut-off values of adequate platelet function inhibition were MARADP < 35% and MARAA < 35%. Data showed that antiplatelet therapy could reduce the maximum aggregation rate. More importantly, adequate platelet function inhibition of either MARADP or MARAA was not associated with the recurrence of stroke/TIA, but adequate platelet function inhibition of not only MARADP but also MARAA predicts lower recurrence (0/121 (0.00%) versus 18/459 (3.92%), P = 0.0188). Conclusion. The platelet function tested by PL-11 demonstrated that adequate inhibition of both MARADP and MARAA could predict lower risk of ischemic stroke/TIA recurrence.

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