Longitudinal Brain Atrophy Rates in Transient Ischemic Attack and Minor Ischemic Stroke Patients and Cognitive Profiles

Background: Evidence about the use of dual antiplatelet therapy (DAPT) with aspirin and P2Y12 inhibitors in patients with acute minor ischemic stroke or transient ischemic attack (TIA) is emerging. The aim of our study was to provide an updated and comprehensive analysis about the risks and benefits of DAPT versus aspirin monotherapy in this setting. Methods: The PubMed, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov databases, main international conference proceedings were searched for randomized controlled trials comparing DAPT versus aspirin monotherapy in patients with acute ischemic stroke or TIA not eligible for thrombolysis or thrombectomy presenting in the first 24 hours after the acute event. Data were pooled by meta-analysis using a random-effects model. The primary efficacy endpoint was ischemic stroke recurrence, and the primary safety outcome was major bleeding. Secondary endpoints were intracranial hemorrhage, hemorrhagic stroke, and all-cause death. Results: A total of 4 studies enrolling 21,459 patients were included. DAPT with clopidogrel was used in 3 studies, DAPT with ticagrelor in one study. DAPT duration was 21 days in one study, 1 month in one study, and 3 months in the remaining studies. DAPT was associated with a significant reduction in the risk of ischemic stroke recurrence (relative risk [RR], 0.74; 95% confidence interval [CI], 0.67-0.82, P<0.001, number needed to treat 50 [95% CI 40-72], while it was associated with a significantly higher risk of major bleeding (RR, 2.59; 95% CI 1.49-4.53, P=0.001, number needed to harm 330 [95% CI 149-1111]), of intracranial hemorrhage (RR 3.06, 95% CI 1.41-6.66, P=0.005), with a trend towards higher risk of hemorrhagic stroke (RR 1.83, 95% CI 0.83-4.05, P=0.14), and a slight tendency towards higher risk of all-cause death (RR 1.30, 95% CI 0.89-1.89, P=0.16). Conclusions: Among patients with acute minor ischemic stroke or TIA, DAPT, as compared with aspirin monotherapy, might offer better effectiveness in terms of ischemic stroke recurrence at the expense of a higher risk of major bleeding. The trade-off between ischemic benefits and bleeding risks should be assessed in tailoring the therapeutic strategies.

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Corneal nerve and endothelial cell damage in patients with transient ischemic attack and minor ischemic stroke

PLoS ONE ◽

10.1371/journal.pone.0213319 ◽

2019 ◽

Vol 14 (3) ◽

pp. e0213319 ◽

Cited By ~ 4

Author(s):

Hoda Gad ◽

Adnan Khan ◽

Naveed Akhtar ◽

Saadat Kamran ◽

Ahmed El-Sotouhy ◽

...

Keyword(s):

Ischemic Stroke ◽

Endothelial Cell ◽

Transient Ischemic Attack ◽

Cell Damage ◽

Endothelial Cell Damage ◽

Minor Ischemic Stroke ◽

Corneal Nerve ◽

Ischemic Attack

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PCV90 RISK FACTORS, USE OF HEALTH CARE RESOURCES, AND MORTALITY IN PATIENTS WITH MINOR ISCHEMIC STROKE OR HIGH-RISK TRANSIENT ISCHEMIC ATTACK

Value in Health ◽

10.1016/j.jval.2019.09.814 ◽

2019 ◽

Vol 22 ◽

pp. S558

Author(s):

O. Fasth ◽

P. Appelros ◽

B. Farahmand ◽

J. Hedberg ◽

P. Ladenvall ◽

...

Keyword(s):

Risk Factors ◽

Health Care ◽

Ischemic Stroke ◽

High Risk ◽

Transient Ischemic Attack ◽

Health Care Resources ◽

Minor Ischemic Stroke ◽

Ischemic Attack ◽

Use Of Health Care

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Diagnostic Usefulness of the ABCD 2 Score to Distinguish Transient Ischemic Attack and Minor Ischemic Stroke From Noncerebrovascular Events

Stroke ◽

10.1161/strokeaha.109.557074 ◽

2009 ◽

Vol 40 (11) ◽

pp. 3449-3454 ◽

Cited By ~ 61

Author(s):

Orla C. Sheehan ◽

Aine Merwick ◽

Lisa A. Kelly ◽

Niamh Hannon ◽

Michael Marnane ◽

...

Keyword(s):

Ischemic Stroke ◽

Transient Ischemic Attack ◽

Minor Ischemic Stroke ◽

Diagnostic Usefulness ◽

Ischemic Attack

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Risk factors for cervical atherosclerosis in patients with transient ischemic attack or minor ischemic stroke.

Stroke ◽

10.1161/01.str.24.7.970 ◽

1993 ◽

Vol 24 (7) ◽

pp. 970-975 ◽

Cited By ~ 25

Author(s):

H Palomäki ◽

M Kaste ◽

R Raininko ◽

O Salonen ◽

S Juvela ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Transient Ischemic Attack ◽

Minor Ischemic Stroke ◽

Ischemic Attack

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Transient ischemic attack and ischemic stroke patients with or without prior stroke

Acta Neurologica Scandinavica ◽

10.1111/ane.12782 ◽

2017 ◽

Vol 136 (6) ◽

pp. 654-659 ◽

Cited By ~ 2

Author(s):

F. Buchwald ◽

B. Norrving ◽

J. Petersson

Keyword(s):

Ischemic Stroke ◽

Transient Ischemic Attack ◽

Stroke Patients ◽

Ischemic Attack ◽

Prior Stroke

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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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Antiplatelet therapy in stroke prevention after non-cardioembolic transient ischemic attack

Neurology neuropsychiatry Psychosomatics ◽

10.14412/2074-2711-2021-5-14-19 ◽

2021 ◽

Vol 13 (5) ◽

pp. 14-19

Author(s):

A. V. Fonyakin ◽

L. A. Geraskina ◽

M. Yu. Maksimova

Keyword(s):

Ischemic Stroke ◽

Antiplatelet Therapy ◽

Transient Ischemic Attack ◽

Antiplatelet Agents ◽

Basic Principles ◽

Advantages And Disadvantages ◽

Minor Ischemic Stroke ◽

New Ideas ◽

Ischemic Attack

The review shows modern concepts on the role of antiplatelet therapy in the secondary prevention of cardiovascular diseases in patients after non-cardioembolic ischemic stroke or transient ischemic attack (TIA). We present an analytical characteristic of all antiplatelet agents that have been studied in randomized controlled trials worldwide. We demonstrate the advantages and disadvantages of each agent in monotherapy and in combination. New ideas about the rationality of the use of combined antiplatelet therapy with clopidogrel and acetylsalicylic acid in the first 24 hours and no more than 90 days in patients with minor ischemic stroke or TIA are discussed. The efficacy and safety of new antiplatelet agents are analyzed. The basic principles of choosing antiplatelet agents in patients after ischemic noncardioembolic stroke/TIA are outlined.

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