scholarly journals One-Year Risk of Stroke After Transient Ischemic Attack or Minor Stroke in Hunter New England, Australia (INSIST Study)

2021 ◽  
Vol 12 ◽  
Author(s):  
Shinya Tomari ◽  
Christopher R. Levi ◽  
Elizabeth Holliday ◽  
Daniel Lasserson ◽  
Jose M. Valderas ◽  
...  
Keyword(s):  
New England ◽  
Transient Ischemic Attack ◽  
Systems Of Care ◽  
Minor Stroke ◽  
Stroke Recurrence ◽  
Carotid Revascularization ◽  
Index Event ◽  
Kaplan Meier ◽  
One Year ◽  
Ischemic Attack

Background: One-year risk of stroke in transient ischemic attack and minor stroke (TIAMS) managed in secondary care settings has been reported as 5–8%. However, evidence for the outcomes of TIAMS in community care settings is limited.Methods: The INternational comparison of Systems of care and patient outcomes In minor Stroke and TIA (INSIST) study was a prospective inception cohort community-based study of patients of 16 general practices in the Hunter–Manning region (New South Wales, Australia). Possible-TIAMS patients were recruited from 2012 to 2016 and followed-up for 12 months post-index event. Adjudication as TIAMS or TIAMS-mimics was by an expert panel. We established 7-days, 90-days, and 1-year risk of stroke, TIA, myocardial infarction (MI), coronary or carotid revascularization procedure and death; and medications use at 24 h post-index event.Results: Of 613 participants (mean age; 70 ± 12 years), 298 (49%) were adjudicated as TIAMS. TIAMS-group participants had ischemic strokes at 7-days, 90-days, and 1-year, at Kaplan-Meier (KM) rates of 1% (95% confidence interval; 0.3, 3.1), 2.1% (0.9, 4.6), and 3.2% (1.7, 6.1), respectively, compared to 0.3, 0.3, and 0.6% of TIAMS-mimic-group participants. At one year, TIAMS-group-participants had twenty-five TIA events (KM rate: 8.8%), two MI events (0.6%), four coronary revascularizations (1.5%), eleven carotid revascularizations (3.9%), and three deaths (1.1%), compared to 1.6, 0.6, 1.0, 0.3, and 0.6% of TIAMS-mimic-group participants. Of 167 TIAMS-group participants who commenced or received enhanced therapies, 95 (57%) were treated within 24 h post-index event. For TIAMS-group participants who commenced or received enhanced therapies, time from symptom onset to treatment was median 9.5 h [IQR 1.8–89.9].Conclusion: One-year risk of stroke in TIAMS participants was lower than reported in previous studies. Early implementation of antiplatelet/anticoagulant therapies may have contributed to the low stroke recurrence.

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

Stroke ◽  
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.

Abstract 41: Prognostic Value of Perfusion MRI in Patients with Transient Ischemic Attack or Minor Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Joon Hwa Lee ◽  
Hyunjin Jo ◽  
Jihoon Cha ◽  
Woo-Keun Seo ◽  
Oh Young Bang ◽  
...  
Keyword(s):  
Cardiovascular Event ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Perfusion Mri ◽  
Minor Stroke ◽  
Secondary Outcome ◽  
Stroke Recurrence ◽  
Composite Outcome ◽  
Stroke Patients ◽  
Ischemic Attack

Background and purpose: We aimed to investigate the role of perfusion MRI parameters (TTP: time to peak, CBF: cerebral blood flow, CBV: cerebral blood volume) as a prognostic factor for the risk of stroke recurrence or cardiovascular outcome in patients with transient ischemic attack (TIA) or minor stroke. Methods: We retrospectively reviewed TIA or minor stroke patients who underwent our stroke MRI protocol (DWI, perfusion MRI, and MRA) in a consecutively collected stroke registry. Primary outcome was nonfatal stroke recurrence and secondary outcome was cardiovascular composite outcome. Multivariate analysis was used to examine the association of perfusion MRI parameters and angiographic findings with the risk of stroke recurrence and cardiovascular event. Results: Of the 326 patients who met inclusion criteria, we identified 15(4.6%) nonfatal strokes and 25(7.7%) cardiovascular composite events during the first 1 year after the index TIA or minor stroke. The presence of regional delayed perfusion on TTP maps (p=0.002) and regional hyperperfusion on CBV maps (p<0.001) were associated with recurrent stroke. In MRA images, concomitant stenosis of the intracranial arteries and/or extracranial carotid arteries was associated with cardiovascular events (p=0.009). Using multivariate cox proportional hazard analysis, presence of regional hyperperfusion on CBV remained an independent predictor of recurrent stroke (HR 10.82, 95% CI 4.19-38.67, p<0.001) and cardiovascular event (HR 6.30, 95% CI 2.67-18.25, p<0.001). The AUC of the CBV maps was also greater than other parameters for the prediction of stroke recurrence (AUC=0.701, 95% CI 0.54-0.86) and cardiovascular composite outcome (AUC=0.628, 95% CI 0.50-0.76). Conclusions: Increased CBV on perfusion MRI, representing the hemodynamic status of postischemic hyperperfusion, could be more useful than other perfusion parameters in predicting poor prognosis of TIA or minor stroke patients.

Nonfocal Symptoms in Patients with Transient Ischemic Attack and Association with Stroke Risk

2021 ◽  
Vol 19 ◽  
Author(s):  
Shuxiang Yang ◽  
Lu Zhao ◽  
Lulu Pei ◽  
Shuang Cao ◽  
Yuan Gao ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Stroke Risk ◽  
First Year ◽  
Kaplan Meier ◽  
Predictive Outcome ◽  
One Year ◽  
Ischemic Attack ◽  
Cumulative Risks

Background and Objective: Patients with transient ischemic attack（TIA）occasionally showed nonfocal symptoms, such as decreased consciousness, amnesia and non-rotatory dizziness. This study intended to evaluate the effect of nonfocal symptoms on the prognosis of patients with TIA. Methods: Data from the prospective hospital-based TIA database of the First Affiliated Hospital of Zhengzhou University were analyzed. The predictive outcome was stroke occurrence at 1 year. Cumulative risks of stroke in patients with and without nonfocal symptoms were estimated with Kaplan-Meier models. Results: We studied 1384 patients with TIA (842 men; mean age, 56±13 years), including 450 (32.5%) with nonfocal symptoms. In the first year after TIA, stroke occurred in 168（12.1%） patients. There was no difference in the risk of stroke between patients with both focal and nonfocal symptoms and patients with focal symptoms alone (11.8% vs 12.4%, log-rank; P=0.691). Conclusions: The occurrence of nonfocal symptoms did not increase the risk of stroke at one-year follow-up compared to the occurrence of focal symptoms alone.

scholarly journals Early and long-term risk of new-onset atrial fibrillation after transient ischemic attack

2021 ◽  
Author(s):  
Francisco Purroy ◽  
Mikel Vicente-Pascual ◽  
Gloria Arque ◽  
Mariona Baraldes-Rovira ◽  
Robert Begue ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Transient Ischemic Attack ◽  
Significant Risk ◽  
Rank Test ◽  
Stroke Recurrence ◽  
Kaplan Meier ◽  
Ischemic Attack ◽  
New Diagnosis ◽  
New Onset

AbstractBackgroundTransient ischemic attack (TIA) provides a unique opportunity to optimize secondary preventive treatments to avoid subsequent ischemic stroke (IS). Although atrial fibrillation (AF) is the leading cause of cardioembolism in IS and anticoagulation prevents stroke recurrence (SR), limited data exists about the risk of new-onset AF after TIA.MethodsWe carried out a prospective cohort study of consecutive patients with TIA from January 2006 to June 2010. The risk of new diagnosis of AF and SR was defined after a median follow-up time of 6.5 (5.0-9.6) years. In a subgroup of consecutive patients, a panel of biomarkers was assessed during the first 24 h of the onset of symptoms.Results723 TIA patients were included. New-onset AF was diagnosed in 116 (16.0%) patients, 42 (36.2%) of them during admission. 204 (28.2%) patients were included in the biomarker substudy. New-onset AF was associated with sex (female) (hazard ratio [HR] 1.61 [95% CI, 1.07-2.41]), age (HR 1.05 [95% CI, 1.03-1.07]), previous ischemic heart disease (HR 1.84 [95% CI 1.15-2.97]) and cortical DWI pattern (HR 2.81 [95% CI 1.87-4.21]). In the Kaplan-Meier analysis, NT-proBNP ≥218.2 pg/ml (log-rank test P<0.001) was associated with significant risk of new-onset AF during the first five years of follow-up. Patients with a new diagnosis of AF after admission and before five years of follow-up had the highest risk of SR (P=0.002).ConclusionThe risk of new diagnosis of AF after TIA is clinically relevant. We identified clinical, neuroimaging and biomarker predictors of new-onset AF.

scholarly journals Early and Long-Term Outcomes of Carotid Stenting and Carotid Endarterectomy in Women

2021 ◽  
Vol 8 ◽  
Author(s):  
Edoardo Pasqui ◽  
Gianmarco de Donato ◽  
Giuseppe Alba ◽  
Brenda Brancaccio ◽  
Claudia Panzano ◽  
...  
Keyword(s):  
Overall Survival ◽  
Transient Ischemic Attack ◽  
Carotid Stenting ◽  
Long Term Outcomes ◽  
Carotid Revascularization ◽  
Kaplan Meier ◽  
Cerebral Ischemic ◽  
Ischemic Attack ◽  
Perioperative Risks

Background: The role of carotid revascularization in women remains intensely debated because of the lower benefit and higher perioperative risks concerning the male counterpart. Carotid artery endarterectomy (CEA) and stenting (CAS) represent the two most valuable stroke prevention techniques due to large vessel disease. This study investigates the early and late outcomes in female sex in a real-world everyday clinical practice.Methods: Data were retrospectively analyzed from a single-center database prospectively compiled. A total of 234 procedures, both symptomatic and asymptomatic, were identified (98 CEAs and 136 CASs). Perioperative risks of death, cerebral ischemic events, and local complications were analyzed and compared between the two groups. Long-term outcomes were evaluated in overall survival, freedom from ipsilateral stroke/transient ischemic attack, and freedom from restenosis (&gt;50%) and reintervention.Results: Women who underwent CAS and CEA did not differ in perioperative ischemic cerebral events (2.2 vs. 0%, p = 0.26) and death (0.8 vs. 0%, p = 1). Other perioperative and 30-day outcomes were similarly distributed within the two groups. Kaplan–Meier curves between CAS and CEA groups highlighted no statistical differences at 6 years in overall survival (77.4 vs. 77.1%, p = 0.47) of ipsilateral stroke/transient ischemic attack (94.1 vs. 92.9%, p = 0.9). Conversely, significant differences were showed in 6 years freedom from restenosis (93.1 vs. 83.3%, p = 0.03) and reinterventions (97.7 vs. 87.8%, p = 0.015).Conclusion: Our results revealed that both CEA and CAS have acceptable perioperative risk in women. Long-term outcomes highlighted favorable indications for both procedures, especially for CAS, which seemed to be an excellent alternative to CEA in female patients when performed by well-trained operators.

scholarly journals One-Year Outcomes After Minor Stroke or High-Risk Transient Ischemic Attack

Stroke ◽  
2017 ◽  
Vol 48 (11) ◽  
pp. 2991-2998 ◽  
Author(s):  
Hong-Kyun Park ◽  
Beom Joon Kim ◽  
Moon-Ku Han ◽  
Jong-Moo Park ◽  
Kyusik Kang ◽  
...  
Keyword(s):  
High Risk ◽  
Transient Ischemic Attack ◽  
Minor Stroke ◽  
One Year ◽  
Ischemic Attack

scholarly journals One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke

2016 ◽  
Vol 374 (16) ◽  
pp. 1533-1542 ◽  
Author(s):  
Pierre Amarenco ◽  
Philippa C. Lavallée ◽  
Julien Labreuche ◽  
Gregory W. Albers ◽  
Natan M. Bornstein ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Minor Stroke ◽  
One Year ◽  
Ischemic Attack

Evaluation of Transient Ischemic Attack and Minor Stroke: A Rapid Outpatient Model for the COVID-19 Pandemic and Beyond

2021 ◽  
pp. 194187442110005
Author(s):  
Paul M. Wechsler ◽  
Neal S. Parikh ◽  
Linda A. Heier ◽  
Evelyn Ruiz ◽  
Matthew E. Fink ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Systems Of Care ◽  
Review Article ◽  
Minor Stroke ◽  
Hospital Treatment ◽  
Evidence Based ◽  
Care Seeking ◽  
Remote Testing ◽  
Stroke Systems Of Care ◽  
Ischemic Attack

The grim circumstances of the COVID-19 pandemic have highlighted the need to refine and adapt stroke systems of care. Patients’ care-seeking behaviors have changed due to perceived risks of in-hospital treatment during the pandemic. In response to these challenges, we optimized a recently implemented, novel outpatient approach for the evaluation and management of minor stroke and transient ischemic attack, entitled RESCUE-TIA. This modified approach incorporated telemedicine visits and remote testing, and proved valuable during the pandemic. In this review article, we provide the evidence-based rationale for our approach, describe its operationalization, and provide data from our initial experience.

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