PATHOGENETIC PREDICTOR OF ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH CARDIOEMBOLIC AND ATHEROTHROMBOTIC TRANSIENT ISCHEMIC ATTACKS

2020 ◽  
pp. 67-71
Author(s):  
Vladimir Anatolevich Vodopianov
Keyword(s):  
Primary Prevention ◽  
Endothelial Dysfunction ◽  
Transient Ischemic Attack ◽  
Clinical Manifestations ◽  
Neurological Symptoms ◽  
Clinical Severity ◽  
Transient Ischemic Attacks ◽  
Vascular Disorders ◽  
Endothelin 1 ◽  
Ischemic Attack

To establish criteria for the severity of pathogenetic disorders in the most common forms of transient ischemic attacks, i.e. cardioembolic and atherothrombotic, a differentiated approach to the treatment and primary prevention of vascular disorders of the cerebral ischemia and dysfunction of ischemia was substantiated. To objectify endothelial dysfunction, endothelin−1 was studied with its principal antagonist − a sodium oxide vasodilator and the major pro−inflammatory cytokine TNF−α. The blood was collected from the patients 12 hours after the first neurological symptoms appeared, the purpose of which was to determine the peak values of the disturbance of biochemical parameters. The data obtained indicate that with a transient ischemic cardioembolic attack, a milder clinical manifestations is caused by less pronounced pathogenetic changes in endothelial dysfunction. At the same time, in atherothrombotic form, the neurological symptoms grow more slowly and have a more pronounced character, which is also confirmed by the study of endothelial dysfunction. Thus, the study of endothelial dysfunction severity in patients with transient ischemic attacks can justify a differentiated pathogenetic approach to treatment and improve the prevention of vascular disorders. Primary prevention in a transient ischemic attack should be directed to causes that are extravasal in nature, and at atherothrombotic treatment to atherosclerosis, mainly reduction of atherosclerotic plaques. Despite quite similar correlation of major vasoconstrictor and vasodilator disorders, a mild and moderate clinical severity due to various occlusion factors is observed. To further determine the occlusion mechanisms, it is necessary to study rheological, coagulation and dynamic parameters of patients' blood. Key words: cardioembolic transient ischemic attack, atherothrombotic transient ischemic attack, endothelial dysfunction, endothelin−1.

scholarly journals Classification of etiologic subtypes for transient ischemic attacks: Clinical significance of lacunar transient ischemic attack

2011 ◽  
Vol 51 (6) ◽  
pp. 406-411 ◽  
Author(s):  
Tomoyuki Ohara ◽  
Yasumasa Yamamoto ◽  
Yoshinari Nagakane ◽  
Eijiro Tanaka ◽  
Fukiko Morii ◽  
...  
Keyword(s):  
Clinical Significance ◽  
Transient Ischemic Attack ◽  
Transient Ischemic Attacks ◽  
Ischemic Attack

scholarly journals Orthostatic Symptoms of Transient Ischemic Attack – Revised

CJEM ◽  
2016 ◽  
Vol 19 (2) ◽  
pp. 163-165
Author(s):  
Ariel Hendin ◽  
Lisa M Fischer ◽  
Jeffrey J Perry
Keyword(s):  
Emergency Department ◽  
Transient Ischemic Attack ◽  
Arterial Occlusion ◽  
Neurological Deficits ◽  
Transient Ischemic Attacks ◽  
Facial Weakness ◽  
Acute Arterial Occlusion ◽  
Common Presentation ◽  
Ischemic Attack ◽  
Orthostatic Symptoms

AbstractTransient ischemic attacks (TIA) are a common presentation to the emergency department (ED) and are associated with an estimated 9% risk of stroke within 90 days.1 We report the case of a 72-year-old female who presented with orthostatic symptoms of facial weakness and dysarthria; that is, the patient’s symptoms were present when she was standing and resolved when supine. Neurological deficits present only when standing should alert the clinician to the importance of advanced neuroimaging to evaluate for acute arterial occlusion.

scholarly journals Sex Differences in Presentation of Stroke: A Systematic Review and Meta-Analysis

Stroke ◽  
2021 ◽  
Author(s):  
Mariam Ali ◽  
Hendrikus J.A. van Os ◽  
Nelleke van der Weerd ◽  
Jan W. Schoones ◽  
Martijn W. Heymans ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sex Differences ◽  
Acute Stroke ◽  
Transient Ischemic Attack ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Neurological Symptoms ◽  
Cross Sectional ◽  
Ischemic Attack ◽  
Meta Analyses

Background and Purpose: Women have worse outcomes than men after stroke. Differences in presentation may lead to misdiagnosis and, in part, explain these disparities. We investigated whether there are sex differences in clinical presentation of acute stroke or transient ischemic attack. Methods: We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Inclusion criteria were (1) cohort, cross-sectional, case-control, or randomized controlled trial design; (2) admission for (suspicion of) ischemic or hemorrhagic stroke or transient ischemic attack; and (3) comparisons possible between sexes in ≥1 nonfocal or focal acute stroke symptom(s). A random-effects model was used for our analyses. We performed sensitivity and subanalyses to help explain heterogeneity and used the Newcastle-Ottawa Scale to assess bias. Results: We included 60 studies (n=582 844; 50% women). In women, headache (pooled odds ratio [OR], 1.24 [95% CI, 1.11–1.39]; I 2 =75.2%; 30 studies) occurred more frequently than in men with any type of stroke, as well as changes in consciousness/mental status (OR, 1.38 [95% CI, 1.19–1.61]; I 2 =95.0%; 17 studies) and coma/stupor (OR, 1.39 [95% CI, 1.25–1.55]; I 2 =27.0%; 13 studies). Aspecific or other neurological symptoms (nonrotatory dizziness and non-neurological symptoms) occurred less frequently in women (OR, 0.96 [95% CI, 0.94–0.97]; I 2 =0.1%; 5 studies). Overall, the presence of focal symptoms was not associated with sex (pooled OR, 1.03) although dysarthria (OR, 1.14 [95% CI, 1.04–1.24]; I 2 =48.6%; 11 studies) and vertigo (OR, 1.23 [95% CI, 1.13–1.34]; I 2 =44.0%; 8 studies) occurred more frequently, whereas symptoms of paresis/hemiparesis (OR, 0.73 [95% CI, 0.54–0.97]; I 2 =72.6%; 7 studies) and focal visual disturbances (OR, 0.83 [95% CI, 0.70–0.99]; I 2 =62.8%; 16 studies) occurred less frequently in women compared with men with any type of stroke. Most studies contained possible sources of bias. Conclusions: There may be substantive differences in nonfocal and focal stroke symptoms between men and women presenting with acute stroke or transient ischemic attack, but sufficiently high-quality studies are lacking. More studies are needed to address this because sex differences in presentation may lead to misdiagnosis and undertreatment.

ENDOTHELIAL DYSFUNCTION IN TRANSIENT ISCHEMIC ATTACK IN THE VERTEBRAL-BASILAR SYSTEM

2019 ◽  
pp. 17-24
Author(s):  
S. I. Henyk ◽  
V. A. Gryb ◽  
L. T. Maksymchuk ◽  
O. O. Doroshenko ◽  
Ya. I. Henyk
Keyword(s):  
Endothelial Dysfunction ◽  
Endothelial Function ◽  
Immunosorbent Assay ◽  
Transient Ischemic Attack ◽  
Stage I ◽  
Stage Iii ◽  
Enzyme Linked Immunosorbent Assay ◽  
Circulatory Insufficiency ◽  
Significant Difference ◽  
Ischemic Attack

Transient ischemic attack (TIA) in the vertebral-basilar system (VBS) is characterized by an acute onset of focal neurological symptoms due to short-term local ischemia of the brain. According to various authors, temporary neurological manifestations of circulatory insufficiency in VBS can progress to complete stroke within 2-5 years in 30-50% of patients, leading to disability of about 80% of patients. Its diagnosis is associated with some difficulties due to the variability of clinical manifestations, clinical similarity with other diseases and, as a consequence, incorrect therapeutic tactics. The aim of the study was to investigate changes of endothelial function in TIA in VBS by determining the levels of homocysteine (HC) and vascular endothelial growth factor (WEGF) at different stages of neurological deficiency (ND). 78 patients with TIA in VBS were examined. The questionnaire developed by us was used to determine the stage of ND in TIA. The level of HC was determined by enzyme-linked immunosorbent assay. WEGF was determined using the "sandwich" method of enzyme-linked immunosorbent assay. In the group of patients with stage I ND, a tendency to HC increase in 1.1 times was detected compared with almost healthy persons (AHP), stage II - HC increased in 1.5 times (p <0.05), and stage III - in 1.9 times (p <0.05). Also significant difference (1.8 times) was revealed at stage III compared to the index of stage I (p <0.05). WEGF at the 1st stage of ND significantly increased in 1,7 times in comparison with AHP (p <0.05), at the 2nd stage there was a tendency to increase (in 1.2 times), at the 3d stage there was a significant increase in WEGF in comparison with AHP (in 2.9 times) (p <0.05), and compared with indicators of I (in 1.8 times) (p <0.05) and II stages (2.6 times) (p <0 , 05). We have shown that TIA in VBS is accompanied by endothelial dysfunction (increase in HC and WEGF), which is more pronounced with aggravation of the ND. To evaluate the prognosis of the disease, we recommend using a questionnaire for determination the stage of ND in TIA in VBS and to identify markers of endothelial function such as HC and WEGF.

scholarly journals Ticagrelor in unstable carotid stenosis - a case report

2021 ◽  
Vol 74 (3-4) ◽  
pp. 123-126
Author(s):  
Aleksandra Ilic ◽  
Vladimir Galic ◽  
Dmitar Vlahovic ◽  
Tamara Rabi-Zikic ◽  
Mirjana Jovicevic ◽  
...  
Keyword(s):  
Case Report ◽  
Platelet Aggregation ◽  
Carotid Stenosis ◽  
Antiplatelet Therapy ◽  
Transient Ischemic Attack ◽  
Dual Antiplatelet Therapy ◽  
Transient Ischemic Attacks ◽  
Suitable Alternative ◽  
Ischemic Attack ◽  
Aggregation Analysis

Introduction. Ticagrelor is an oral, reversible, direct-acting inhibitor of adenosine diphosphate receptor P2Y12, which has a faster onset of action and stronger inhibition of platelet aggregation than clopidogrel. Case Report. This case report describes a 54-year-old male patient with repeated, transient ischemic attacks due to ipsilateral, significant carotid stenosis registered by carotid duplex ultrasound. In addition to aspirin, clopidogrel and rosuvastatin were added to the therapy. Despite optimal treatment, the patient was continuously unstable with frequent but transient neurological symptoms. A magnetic resonance imaging of the brain showed acute, cortical-subcortical ischemic lesions in the left frontal and parietal lobes, while the computed tomography angiography of the endocranium showed progression of findings and occlusion of the left common carotid artery. Subsequently, laboratory platelet aggregation analysis confirmed aspirin resistance and poor response to clopidogrel. Episodes of transient ischemic attacks were stabilized after the exclusion of dual antiplatelet therapy and introduction of ticagrelor. After that, the patient?s symptoms did not recur and he remained stable. Conclusion. The incidence of resistance to antiplatelet therapy in patients with stroke or transient ischemic attack varies greatly and ranges from 3% to 85% for aspirin, and 28% to 44% for clopidogrel. Our case showed that platelet aggregation analysis is reasonable if patients with transient ischemic attack or minor acute ischemic stroke are neurologically unstable, despite optimal medical treatment and when other therapeutic options, such as carotid revascularization, are not indicated. In such situations, ticagrelor may be a suitable alternative to dual antiplatelet therapy.

scholarly journals Prevalence of Thrombophilia in Transient Ischemic Attack and Ischemic Stroke Patients

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 3-3
Author(s):  
Omar Raslan ◽  
Christopher Tran ◽  
Fatimah Al-Ani ◽  
Luciano Sposato ◽  
Alejandro Lazo-Langner
Keyword(s):  
Ischemic Stroke ◽  
High Risk ◽  
Transient Ischemic Attack ◽  
Patent Foramen Ovale ◽  
Research Funding ◽  
Transient Ischemic Attacks ◽  
Foramen Ovale ◽  
Stroke Patients ◽  
Thrombophilia Screening ◽  
Ischemic Attack

Introduction. Screening for inherited thrombophilia has been recommended in patients with cryptogenic ischemic strokes and anticoagulant therapy is frequently indicated based on these results. However, current evidence suggests that thrombophilia screening is over utilized in stroke patients and may provide more risks than benefits. Patients and Methods.We conducted a retrospective cohort study in patients with transient ischemic attack (TIA) or ischemic stroke who had a thrombophilia screen and determined the proportions of each thrombophilia trait, and the proportion of high risk thrombophilia in this population. Pre-specified subgroup analyses were conducted for patients with ischemic stroke and transient ischemic attacks, and for patients with patent foramen ovale. Results.We included 412 patients (152 male and 260 female). The prevalence of thrombophilia was 7.52% (95% CI 5.35-10.48). The proportion of major thrombophilia was 2.18 (95% CI=1.15 - 4.09). The proportion of thrombophilia traits in ischemic stroke patients was lower 4.92% (95% CI 2.61 - 9.08) than that in patients with transient ischemic attacks 9.57% (95% CI = 6.41 - 14.06); Only 2 individuals had both a positive thrombophilia screen and a patent foramen ovale. Discussion. In this study the prevalence of thrombophilia traits in patients with ischemic stroke or transient ischemic attack was low, including high risk thrombophilic traits. Further studies are needed to determine if thrombophilia screening exposes these patients to additional risks without any benefits. Disclosures Sposato: Western University:Other: Kathleen and Dr. Henry Barnett Chair in Stroke Research;Boehringer Ingelheim:Honoraria, Research Funding;Pfizer:Honoraria, Research Funding;Gore:Honoraria, Research Funding;Bayer:Honoraria, Research Funding.

ENDOTHELIAL DYSFUNCTION IN TRANSIENT ISCHEMIC ATTACK IN THE VERTEBRAL-BASILAR SYSTEM

2019 ◽  
pp. 17-24
Author(s):  
С. І. Геник ◽  
В. А. Гриб ◽  
Л. Т. Максимчук ◽  
О. О. Дорошенко ◽  
Я. І. Геник
Keyword(s):  
Endothelial Dysfunction ◽  
Endothelial Function ◽  
Immunosorbent Assay ◽  
Transient Ischemic Attack ◽  
Stage I ◽  
Stage Iii ◽  
Enzyme Linked Immunosorbent Assay ◽  
Circulatory Insufficiency ◽  
Significant Difference ◽  
Ischemic Attack

Transient ischemic attack (TIA) in the vertebral-basilar system (VBS) is characterized by an acute onset of focal neurological symptoms due to short-term local ischemia of the brain. According to various authors, temporary neurological manifestations of circulatory insufficiency in VBS can progress to complete stroke within 2-5 years in 30-50% of patients, leading to disability of about 80% of patients. Its diagnosis is associated with some difficulties due to the variability of clinical manifestations, clinical similarity with other diseases and, as a consequence, incorrect therapeutic tactics. The aim of the study was to investigate changes of endothelial function in TIA in VBS by determining the levels of homocysteine (HC) and vascular endothelial growth factor (WEGF) at different stages of neurological deficiency (ND). 78 patients with TIA in VBS were examined. The questionnaire developed by us was used to determine the stage of ND in TIA. The level of HC was determined by enzyme-linked immunosorbent assay. WEGF was determined using the "sandwich" method of enzyme-linked immunosorbent assay. In the group of patients with stage I ND, a tendency to HC increase in 1.1 times was detected compared with almost healthy persons (AHP), stage II - HC increased in 1.5 times (p <0.05), and stage III - in 1.9 times (p <0.05). Also significant difference (1.8 times) was revealed at stage III compared to the index of stage I (p <0.05). WEGF at the 1st stage of ND significantly increased in 1,7 times in comparison with AHP (p <0.05), at the 2nd stage there was a tendency to increase (in 1.2 times), at the 3d stage there was a significant increase in WEGF in comparison with AHP (in 2.9 times) (p <0.05), and compared with indicators of I (in 1.8 times) (p <0.05) and II stages (2.6 times) (p <0 , 05). We have shown that TIA in VBS is accompanied by endothelial dysfunction (increase in HC and WEGF), which is more pronounced with aggravation of the ND. To evaluate the prognosis of the disease, we recommend using a questionnaire for determination the stage of ND in TIA in VBS and to identify markers of endothelial function such as HC and WEGF.

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