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Lang AE, de Havenon A, Mac Grory B, Henninger N, Shu L, Furie KL, Easton JD, Kim A, Johnston SC, Yaghi S. Subsequent ischemic stroke and tobacco smoking: A secondary analysis of the POINT trial. Eur Stroke J 2022; 8:328-333. [PMID: 37021190 PMCID: PMC10069178 DOI: 10.1177/23969873221148224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/12/2022] [Indexed: 12/30/2022] Open
Abstract
Background: The aim of this study was to determine the effect of smoking status on subsequent stroke risk in patients with minor ischemic stroke or TIA and to determine whether smoking modifies the effect of clopidogrel-based DAPT on subsequent stroke risk. Methods: This was a post-hoc analysis of the Platelet Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial, which had a 90-day follow-up period. We used multivariable Cox regression and subgroup interaction analysis to determine the effect of smoking on the risk of subsequent ischemic stroke and major hemorrhage, respectively. Results: Data from 4877 participants enrolled in the POINT trial were analyzed. Among these, 1004 were current smokers and 3873 were non-smokers at the time of index event. Smoking was associated with a non-significant trend toward an increased risk of subsequent ischemic stroke during follow up (adjusted HR, 1.31 (95% CI, 0.97–1.78), p = 0.076). The effect of clopidogrel on ischemic stroke did not differ between non-smokers (HR, 0.74 (95% CI, 0.56–0.98), p = 0.03) and smokers (HR, 0.63 (95% CI, 0.37–1.05), p = 0.078), p for interaction = 0.572. Similarly, the effect of clopidogrel on major hemorrhage did not differ between non-smokers (hazard ratio, 1.67 (95% CI, 0.40–7.00), p = 0.481) and smokers (HR, 2.59 (95% CI, 1.08–6.21), p = 0.032), p for interaction = 0.613. Conclusions: In this post-hoc analysis of the POINT trial we found that the effect of clopidogrel on reducing subsequent ischemic stroke as well as risk of major hemorrhage did not depend on smoking status, indicating that smokers benefit to a similar degree from DAPT as non-smokers.
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Affiliation(s)
- Adam Edward Lang
- Department of Primary Care, McDonald Army Health Center, Fort Eustis, VA, USA
- Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Adam de Havenon
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Brian Mac Grory
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Liqi Shu
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Karen L. Furie
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - J Donald Easton
- Department of Neurology, University of California, San Francisco, Sandler Neurosciences Center, San Francisco, CA, USA
| | - Anthony Kim
- Department of Neurology, University of California, San Francisco, Sandler Neurosciences Center, San Francisco, CA, USA
| | | | - Shadi Yaghi
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA
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2
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Shahjouei S, Li J, Koza E, Abedi V, Sadr AV, Chen Q, Mowla A, Griffin P, Ranta A, Zand R. Risk of Subsequent Stroke Among Patients Receiving Outpatient vs Inpatient Care for Transient Ischemic Attack: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2136644. [PMID: 34985520 PMCID: PMC8733831 DOI: 10.1001/jamanetworkopen.2021.36644] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Transient ischemic attack (TIA) often indicates a high risk of subsequent cerebral ischemic events. Timely preventive measures improve the outcome. OBJECTIVE To estimate and compare the risk of subsequent ischemic stroke among patients with TIA or minor ischemic stroke (mIS) by care setting. DATA SOURCES MEDLINE, Web of Science, Scopus, Embase, International Clinical Trials Registry Platform, ClinicalTrials.gov, Trip Medical Database, CINAHL, and all Evidence-Based Medicine review series were searched from the inception of each database until October 1, 2020. STUDY SELECTION Studies evaluating the occurrence of ischemic stroke after TIA or mIS were included. Cohorts without data on evaluation time for reporting subsequent stroke, with retrospective diagnosis of the index event after stroke occurrence, and with a report of outcomes that were not limited to patients with TIA or mIS were excluded. Two authors independently screened the titles and abstracts and provided the list of candidate studies for full-text review; discrepancies and disagreements in all steps of the review were addressed by input from a third reviewer. DATA EXTRACTION AND SYNTHESIS The study was prepared and reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses, Meta-analysis of Observational Studies in Epidemiology, Methodological Expectations of Cochrane Intervention Reviews, and Enhancing the Quality and Transparency of Health Research guidelines. The Risk of Bias in Nonrandomized Studies-of Exposures (ROBINS-E) tool was used for critical appraisal of cohorts, and funnel plots, Begg-Mazumdar rank correlation, Kendall τ2, and the Egger bias test were used for evaluating the publication bias. All meta-analyses were conducted under random-effects models. MAIN OUTCOMES AND MEASURES Risk of subsequent ischemic stroke among patients with TIA or mIS who received care at rapid-access TIA or neurology clinics, inpatient units, emergency departments (EDs), and unspecified or multiple settings within 4 evaluation intervals (ie, 2, 7, 30, and 90 days). RESULTS The analysis included 226 683 patients from 71 articles recruited between 1981 and 2018; 5636 patients received care at TIA clinics (mean [SD] age, 65.7 [3.9] years; 2291 of 4513 [50.8%] men), 130 139 as inpatients (mean [SD] age, 78.3 [4.0] years; 49 458 of 128 745 [38.4%] men), 3605 at EDs (mean [SD] age, 68.9 [3.9] years; 1596 of 3046 [52.4%] men), and 87 303 patients received care in an unspecified setting (mean [SD] age, 70.8 [3.8] years, 43 495 of 87 303 [49.8%] men). Among the patients who were treated at a TIA clinic, the risk of subsequent stroke following a TIA or mIS was 0.3% (95% CI, 0.0%-1.2%) within 2 days, 1.0% (95% CI, 0.3%-2.0%) within 7 days, 1.3% (95% CI, 0.4%-2.6%) within 30 days, and 2.1% (95% CI, 1.4%-2.8%) within 90 days. Among the patients who were treated as inpatients, the risk of subsequent stroke was to 0.5% (95% CI, 0.1%-1.1%) within 2 days, 1.2% (95% CI, 0.4%-2.2%) within 7 days, 1.6% (95% CI, 0.6%-3.1%) within 30 days, and 2.8% (95% CI, 2.1%-3.5%) within 90 days. The risk of stroke among patients treated at TIA clinics was not significantly different from those hospitalized. Compared with the inpatient cohort, TIA clinic patients were younger and had had lower ABCD2 (age, blood pressure, clinical features, duration of TIA, diabetes) scores (inpatients with ABCD2 score >3, 1101 of 1806 [61.0%]; TIA clinic patients with ABCD2 score >3, 1933 of 3703 [52.2%]). CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, the risk of subsequent stroke among patients who were evaluated in a TIA clinic was not higher than those hospitalized. Patients who received treatment in EDs without further follow-up had a higher risk of subsequent stroke. These findings suggest that TIA clinics can be an effective component of the TIA care component pathway.
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Affiliation(s)
- Shima Shahjouei
- Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania
| | - Jiang Li
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, Pennsylvania
| | - Eric Koza
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Vida Abedi
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, Pennsylvania
- Biocomplexity Institute, Virginia Tech, Blacksburg, Virginia
| | - Alireza Vafaei Sadr
- Department de Physique Theorique and Center for Astroparticle Physics, University Geneva, Geneva, Switzerland
| | - Qiushi Chen
- Department of Industrial and Manufacturing Engineering, Pennsylvania State University, University Park
| | - Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles
| | - Paul Griffin
- Department of Industrial and Manufacturing Engineering, Pennsylvania State University, University Park
| | - Annemarei Ranta
- Department of Neurology, Wellington Hospital, Wellington, New Zealand
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Ramin Zand
- Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania
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3
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Wang H, Lu H, Zhang XM, Goto KI, Kobayashi E, Yoshida Y, Adachi A, Matsutani T, Iwadate Y, Mine S, Machida T, Sata M, Yamagishi K, Iso H, Sawada N, Tsugane S, Kamitsukasa I, Wada T, Aotsuka A, Sugimoto K, Takizawa H, Kashiwado K, Shin H, Tomiyoshi G, Nakamura R, Shinmen N, Kuroda H, Xu A, Hiwasa T. Association of serum levels of antibodies against ALDOA and FH4 with transient ischemic attack and cerebral infarction. BMC Neurol 2021; 21:274. [PMID: 34243715 PMCID: PMC8268454 DOI: 10.1186/s12883-021-02301-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background Ischemic stroke, including transient ischemic attack (TIA) and acute-phase cerebral infarction (aCI), is a serious health problem in the aging society. Thus, this study aimed to identify TIA and aCI biomarkers. Methods In 19 patients with TIA, candidate antigens recognized by serum IgG autoantibodies were screened using a human aortic endothelial cell cDNA library. Through amplified luminescent proximity homogeneous assay-linked immunosorbent assay (AlphaLISA), serum antibody levels against the candidate antigens were examined in healthy donor (HD), TIA, and aCI cohorts (n = 285, 92, and 529). The plasma antibody levels in the Japan Public Health Center-based Prospective Cohort Study (1991–1993) were also examined. Results The candidate antigens were aldolase A (ALDOA) and fumarate hydratase (FH). In AlphaLISA, patients with TIA or aCI had higher anti-ALDOA antibody (ALDOA-Ab) and anti-FH antibody (FH-Ab) levels than the HDs (P < 0.05). In a multivariate logistic regression analysis, the ALDOA-Ab (odds ratio [OR]: 2.46, P = 0.0050) and FH-Ab (OR: 2.49, P = 0.0037) levels were independent predictors of TIA. According to the case–control study, the ALDOA-Ab (OR: 2.50, P < 0.01) and FH-Ab (OR: 2.60, P < 0.01) levels were associated with aCI risk. In a correlation analysis, both ALDOA-Abs and FH-Abs were well associated with hypertension, coronary heart disease, and habitual smoking. These antibody levels also correlated well with maximum intima–media thickness, which reflects atherosclerotic stenosis. Conclusions ALDOA-Abs and FH-Abs can be novel potential biomarkers for predicting atherosclerotic TIA and aCI.
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Affiliation(s)
- Hao Wang
- Stroke Center, the First Affiliated Hospital, Jinan University, NO. 613, West Huangpu Ave., Tianhe Dist., Guangzhou, 510630, China.,Department of Biochemistry and Genetics, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Hao Lu
- Stroke Center, the First Affiliated Hospital, Jinan University, NO. 613, West Huangpu Ave., Tianhe Dist., Guangzhou, 510630, China
| | - Xiao-Meng Zhang
- Department of Biochemistry and Genetics, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Ken-Ichiro Goto
- Department of Biochemistry and Genetics, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Eiichi Kobayashi
- Department of Neurological Surgery, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba, 260-8670, Japan.,Comprehensive Stroke Center, Chiba University Hospital, Chiba, 260-8677, Japan
| | - Yoichi Yoshida
- Department of Biochemistry and Genetics, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan.,Department of Neurological Surgery, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba, 260-8670, Japan.,Comprehensive Stroke Center, Chiba University Hospital, Chiba, 260-8677, Japan
| | - Akihiko Adachi
- Department of Neurological Surgery, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba, 260-8670, Japan
| | - Tomoo Matsutani
- Department of Neurological Surgery, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba, 260-8670, Japan
| | - Yasuo Iwadate
- Department of Neurological Surgery, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba, 260-8670, Japan.,Comprehensive Stroke Center, Chiba University Hospital, Chiba, 260-8677, Japan
| | - Seiichiro Mine
- Department of Neurological Surgery, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba, 260-8670, Japan.,Department of Neurological Surgery, Chiba Prefectural Sawara Hospital, Chiba, 287-0003, Japan.,Department of Neurological Surgery, Chiba Cerebral and Cardiovascular Center, Chiba, 290-0512, Japan
| | - Toshio Machida
- Department of Neurological Surgery, Chiba Cerebral and Cardiovascular Center, Chiba, 290-0512, Japan.,Department of Neurosurgery, Eastern Chiba Medical Center, Chiba, 283-8686, Japan
| | - Mizuki Sata
- Department of Public Health, Social Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroyasu Iso
- Department of Public Health, Social Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Norie Sawada
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Ikuo Kamitsukasa
- Department of Neurology, Chiba Rosai Hospital, Chiba, 290-0003, Japan.,Department of Neurology, Chibaken Saiseikai Narashino Hospital, Chiba, 275-8580, Japan
| | - Takeshi Wada
- Department of Internal Medicine, Chiba Aoba Municipal Hospital, Chiba, 260-0852, Japan
| | - Akiyo Aotsuka
- Department of Internal Medicine, Chiba Aoba Municipal Hospital, Chiba, 260-0852, Japan
| | - Kazuo Sugimoto
- Department of Biochemistry and Genetics, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan.,Department of Neurology, Dongzhimen Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Hirotaka Takizawa
- Port Square Kashiwado Clinic, Kashiwado Memorial Foundation, Chiba, 260-0025, Japan
| | - Koichi Kashiwado
- Department of Neurology, Kashiwado Hospital, Chiba, 260-0854, Japan
| | - Hideo Shin
- Department of Neurosurgery, Higashi Funabashi Hospital, Chiba, 274-0065, Japan
| | - Go Tomiyoshi
- Department of Biochemistry and Genetics, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan.,Medical Project Division, Research Development Center, Fujikura Kasei Co., Saitama, 340-0203, Japan
| | - Rika Nakamura
- Department of Biochemistry and Genetics, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan.,Medical Project Division, Research Development Center, Fujikura Kasei Co., Saitama, 340-0203, Japan
| | - Natsuko Shinmen
- Department of Biochemistry and Genetics, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan.,Medical Project Division, Research Development Center, Fujikura Kasei Co., Saitama, 340-0203, Japan
| | - Hideyuki Kuroda
- Medical Project Division, Research Development Center, Fujikura Kasei Co., Saitama, 340-0203, Japan
| | - Anding Xu
- Stroke Center, the First Affiliated Hospital, Jinan University, NO. 613, West Huangpu Ave., Tianhe Dist., Guangzhou, 510630, China.
| | - Takaki Hiwasa
- Department of Biochemistry and Genetics, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan. .,Department of Neurological Surgery, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba, 260-8670, Japan. .,Comprehensive Stroke Center, Chiba University Hospital, Chiba, 260-8677, Japan.
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Shahjouei S, Sadighi A, Chaudhary D, Li J, Abedi V, Holland N, Phipps M, Zand R. A 5-Decade Analysis of Incidence Trends of Ischemic Stroke After Transient Ischemic Attack: A Systematic Review and Meta-analysis. JAMA Neurol 2021; 78:77-87. [PMID: 33044505 DOI: 10.1001/jamaneurol.2020.3627] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Management of transient ischemic attack (TIA) has gained significant attention during the past 25 years after several landmark studies indicated the high incidence of a subsequent stroke. Objective To calculate the pooled event rate of subsequent ischemic stroke within 2, 7, 30, and 90 days of a TIA and compare this incidence among the population with TIA recruited before 1999 (group A), from 1999 to 2007 (group B), and after 2007 (group C). Data Sources All published studies of TIA outcomes were obtained by searching PubMed from 1996, to the last update on January 31, 2020, irrespective of the study design, document type, or language. Study Selection Of 11 516 identified citations, 175 articles were relevant to this review. Both the classic time-based definition of TIA and the new tissue-based definition were accepted. Studies with a combined record of patients with TIA and ischemic stroke, without clinical evaluation for the index TIA, with diagnosis of index TIA event after ischemic stroke occurrence, with low suspicion for TIA, or duplicate reports of the same database were excluded. Data Extraction and Synthesis The study was conducted and reported according to the PRISMA, MOOSE, and EQUATOR guidelines. Critical appraisal and methodological quality assessment used the Quality in Prognosis Studies tool. Publication bias was visualized by funnel plots and measured by the Begg-Mazumdar rank correlation Kendall τ2 statistic and Egger bias test. Data were pooled using double arcsine transformations, DerSimonian-Laird estimator, and random-effects models. Main Outcomes and Measures The proportion of the early ischemic stroke after TIA within 4 evaluation intervals (2, 7, 30, and 90 days) was considered as effect size. Results Systematic review yielded 68 unique studies with 223 866 unique patients from 1971 to 2019. The meta-analysis included 206 455 patients (58% women) during a span of 4 decades. The overall subsequent ischemic stroke incidence rates were estimated as 2.4% (95% CI, 1.8%-3.2%) within 2 days, 3.8% (95% CI, 2.5%-5.4%) within 7 days, 4.1% (95% CI, 2.4%-6.3%) within 30 days, and 4.7% (95% CI, 3.3%-6.4%) within 90 days. There was a recurrence risk of 3.4% among group A in comparison with 2.1% in group B or 2.1% in group C within 2 days; 5.5% in group A vs 2.9% in group B or 3.2% in group C within 7 days; 6.3% in group A vs 2.9% in group B or 3.4% in group C within 30 days, and 7.4% in group A vs 3.9% in group B or 3.9% in group C within 90 days. Conclusions and Relevance These findings suggest that TIA continues to be associated with a high risk of early stroke; however, the rate of post-TIA stroke might have decreased slightly during the past 2 decades.
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Affiliation(s)
- Shima Shahjouei
- Department of Neurology, Geisinger Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania
| | - Alireza Sadighi
- Department of Neurology, Geisinger Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania
| | - Durgesh Chaudhary
- Department of Neurology, Geisinger Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania
| | - Jiang Li
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, Pennsylvania
| | - Vida Abedi
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, Pennsylvania.,Biocomplexity Institute, Virginia Tech, Blacksburg, Virginia
| | - Neil Holland
- Department of Neurology, Geisinger Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania
| | - Michael Phipps
- Department of Neurology, University of Maryland, Baltimore
| | - Ramin Zand
- Department of Neurology, Geisinger Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania
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ABCD3-I and ABCD2 Scores in a TIA Population with Low Stroke Risk. Stroke Res Treat 2021; 2021:8845898. [PMID: 33708373 PMCID: PMC7932764 DOI: 10.1155/2021/8845898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/20/2021] [Accepted: 02/06/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives We aimed to evaluate the ABCD3-I score and compare it with the ABCD2 score in short- (1 week) and long-term (3 months; 1 year) stroke risk prediction in our post-TIA stroke risk study, MIDNOR TIA. Materials and Methods We performed a prospective, multicenter study in Central Norway from 2012 to 2015, enrolling 577 patients with TIA. In a subset of patients with complete data for both scores (n = 305), we calculated the AUC statistics of the ABCD3-I score and compared this with the ABCD2 score. A telephone follow-up and registry data were used for assessing stroke occurrence. Results Within 1 week, 3 months, and 1 year, 1.0% (n = 3), 3.3% (n = 10), and 5.2% (n = 16) experienced a stroke, respectively. The AUCs for the ABCD3-I score were 0.72 (95% CI, 0.54 to 0.89) at 1 week, 0.66 (95% CI, 0.53 to 0.80) at 3 months, and 0.68 (0.95% CI, 0.56 to 0.79) at 1 year. The corresponding AUCs for the ABCD2 score were 0.55 (95% CI, 0.24 to 0.86), 0.55 (95% CI, 0.42 to 0.68), and 0.63 (95% CI, 0.50 to 0.76). Conclusions The ABCD3-I score had limited value in a short-term prediction of subsequent stroke after TIA and did not reliably discriminate between low- and high-risk patients in a long-term follow-up. The ABCD2 score did not predict subsequent stroke accurately at any time point. Since there is a generally lower stroke risk after TIA during the last years, the benefit of these clinical risk scores and their role in TIA management seems limited. Clinical Trial Registration. This trial is registered with NCT02038725 (retrospectively registered, January 16, 2014).
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Yuan J, Shan GL, Li SD, Gao CP, Cui LY, Peng B. Risk Factors Influencing Seeking Emergency Medical Service in Urban and Rural China Among Participants With a Previous Transient Ischemic Attack. Front Neurol 2021; 11:620157. [PMID: 33613421 PMCID: PMC7889803 DOI: 10.3389/fneur.2020.620157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/21/2020] [Indexed: 01/10/2023] Open
Abstract
Objective: It is critical to identify factors that significantly impede the correct action of calling emergency medical service (EMS) in the high-risk population with a previous history of transient ischemic attack (TIA) and further explore the urban–rural difference in China. Methods: Participants with previous TIA from the China National Stroke Screening Survey and its branch study (FAST-RIGHT) were interviewed cross-sectionally (n = 2,036). The associations between the outcome measure of not calling EMS and multiple potential risk factors were examined, including demographic information, live (or not) with families, medical insurance type, urban or rural residence, awareness of stroke symptoms, annual personal income, presence of cardiovascular disease or risk factors, and stroke history in family members or friends. The sample was further stratified to explore the urban–rural difference by their residency. Results: The proportion of not calling EMS was 36.8% among all participants with previous TIA, and these were 21.7 and 48.4% among urban and rural participants, respectively. Among rural participants, risk factors that were significantly associated with not calling EMS included primary school education [odds ratio (OR) 2.50, 95% confidence interval (CI) 1.89–3.33], living with family (OR 2.09, 95% CI 1.33–3.36), unaware stroke symptoms (OR 2.60, 95% CI 1.81–3.78), and low income (OR 1.57, 95% CI 1.19–2.07). Among urban participants, only low income was significantly associated with an increased risk of not calling EMS (OR 1.74, 95% CI 1.10–2.72). Conclusions: Rural residents with previous TIA in China had a higher percentage of not calling EMS. Multiple risk factors have been identified that call for targeted intervention strategies.
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Affiliation(s)
- Jing Yuan
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Guang-Liang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Sheng-De Li
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chun-Peng Gao
- Disease Control and Prevention Office, Dalian Municipal Central Hospital, Dalian, China
| | - Li-Ying Cui
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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7
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Temporal Trends of Sex Differences in Transient Ischemic Attack Incidence Within a Population. J Stroke Cerebrovasc Dis 2019; 28:2468-2474. [PMID: 31270019 DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/12/2019] [Accepted: 06/15/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Previously we reported that ischemic stroke incidence is declining over time for men but not women. We sought to describe temporal trends of sex differences in incidence of transient ischemic attack (TIA) within the same large, biracial population. METHODS Among the population of 1.3 million in the Greater Cincinnati Northern Kentucky Stroke Study (GCNKSS) region, TIAs among area residents (≥20 years old) were identified at all local hospitals. Out of hospital cases were ascertained using a sampling scheme. First-ever cases and first within each study period for a patient was included in incidence rates. All cases were physician-adjudicated. Incidence rates (during July 93-June 94 and calendar years 1999, 2005, and 2010) were calculated using the age-, race-, and sex-specific number of TIAs divided by the GCNKSS population in that group; rates were standardized to the 2010 U.S. POPULATION t Tests with Bonferroni correction were used to compare rates over time. RESULTS There were a total of 4746 TIA events; 53% were female, and 12% were black. In males, incidence decreased from 153 (95% confidence interval [CI] 139-167) per 100,000 in 1993/4 to 117 (95% CI 107-128) in 2010 (P < .05 for trend test) but was similar over time among females (107 (95% CI 97-116) to 102 (95%CI 94-111), P > .05). CONCLUSIONS Within the GCNKSS population, TIA incidence decreased significantly over time in males but not females, data which parallels trends in ischemic stroke in the GCNKSS over the same time period. Future research is needed to determine if these sex differences in incidence over time continue past 2010.
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Bakouni H, Nahas MA. Carotid artery stenting vs. carotid endarterectomy: a comparative non-randomized study in two university hospitals. Chirurgia (Bucur) 2019. [DOI: 10.23736/s0394-9508.18.04857-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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9
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Murray CSG, Nahar T, Kalashyan H, Becher H, Nanda NC. Ultrasound assessment of carotid arteries: Current concepts, methodologies, diagnostic criteria, and technological advancements. Echocardiography 2019; 35:2079-2091. [PMID: 30506607 DOI: 10.1111/echo.14197] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 01/06/2023] Open
Abstract
Following cardiac disease and cancer, stroke continues to be the third leading cause of death and disability due to chronic disease in the developed world. Appropriate screening tools are integral to early detection and prevention of major cardiovascular events. In a carotid artery, the presence of increased intima-media thickness, plaque, or stenosis is associated with increased risk of a transient ischemic attack or a stroke. Carotid artery ultrasound remains a long-standing and reliable tool in the current armamentarium of diagnostic modalities used to assess vascular morbidity at an early stage. The procedure has, over the last two decades, undergone considerable upgrades in technology, approach, and utility. This review examines in detail the current state and usage of this integrally important means of extracranial cerebrovascular assessment.
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Affiliation(s)
- Christopher S G Murray
- Department of Internal Medicine, Harlem Hospital Center/Columbia University, New York, New York
| | - Tamanna Nahar
- Section of Cardiology, Department of Internal Medicine, Harlem Hospital Center/Columbia University, New York, New York
| | - Hayrapet Kalashyan
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Harald Becher
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Navin C Nanda
- Department of Internal Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
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10
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Zrelak PA. Sex-Based Differences in Symptom Perception and Care-Seeking Behavior in Acute Stroke. Perm J 2019; 22:18-042. [PMID: 30285913 DOI: 10.7812/tpp/18-042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
CONTEXT Lack of early stroke recognition and delays in seeking emergency care by persons experiencing a stroke severely limit acute treatment options. Sparse and sometimes conflicting evidence suggests sex differences in care-seeking behaviors in stroke, stroke knowledge, perceptions of stroke symptoms, and the importance of physical location at the time of stroke and of having a witnessed stroke. OBJECTIVE To explore specific sex-based differences in stroke presentation and associated care-seeking behaviors. DESIGN Descriptive study based on a convenience sample of 60 patients with stroke admitted to an academic medical center in Northern California. MAIN OUTCOME MEASURES Impact of the patient's sex on 1) time to presentation (early [≤ 4.5 hours] vs late [> 4.5 hours]); 2) perception of symptoms and clinical signs; 3) stroke knowledge and decision making; 4) physical location at the time of stroke; and 5) bystander presence and assistance with decision making. RESULTS There was a discrepancy between how patients perceive symptoms and their medical findings on physical examination. Although most patients had at least one sign or symptom associated with nationally used stroke recognition acronyms, both sexes delayed care because they did not perceive their symptoms as urgent. Early-presenting men were more likely to have a higher stroke severity score at admission, receive alteplase, arrive by Emergency Medical Services, and have a witnessed stroke. Both early- and late-presenting women reported more nonfocal symptoms than did men. CONCLUSION This study suggests that there are sex-based differences in symptom perception and care-seeking behavior in acute ischemic stroke.
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Affiliation(s)
- Patricia A Zrelak
- Clinical Practice Consultant at the Kaiser Foundation Hospital in Sacramento, CA
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11
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Early carotid endarterectomy performed 2 to 5 days after the onset of neurologic symptoms leads to comparable results to carotid endarterectomy performed at later time points. J Vasc Surg 2017; 66:1719-1726. [DOI: 10.1016/j.jvs.2017.05.101] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/07/2017] [Indexed: 11/19/2022]
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12
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Abstract
Significant advances in our understanding of transient ischemic attack (TIA) have taken place since it was first recognized as a major risk factor for stroke during the late 1950's. Recently, numerous studies have consistently shown that patients who have experienced a TIA constitute a heterogeneous population, with multiple causative factors as well as an average 5–10% risk of suffering a stroke during the 30 days that follow the index event. These two attributes have driven the most important changes in the management of TIA patients over the last decade, with particular attention paid to effective stroke risk stratification, efficient and comprehensive diagnostic assessment, and a sound therapeutic approach, destined to reduce the risk of subsequent ischemic stroke. This review is an outline of these changes, including a discussion of their advantages and disadvantages, and references to how new trends are likely to influence the future care of these patients.
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Affiliation(s)
- Camilo R Gomez
- Department of Neurology, Loyola University Medical Center, Maywood, IL, USA
| | - Michael J Schneck
- Department of Neurology, Loyola University Medical Center, Maywood, IL, USA
| | - Jose Biller
- Department of Neurology, Loyola University Medical Center, Maywood, IL, USA
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13
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Sarfo FS, Gyamfi RA, Adamu S, Sarfo-Kantanka O, Owolabi M, Ovbiagele B. Administration of a pictorial questionnaire to screen for stroke among patients with hypertension or diabetes in rural Ghana. J Neurol Sci 2017; 373:289-294. [PMID: 28131208 DOI: 10.1016/j.jns.2017.01.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/04/2017] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Stroke prevention is an important public health goal in low-and-middle income countries (LMIC) due to its high mortality and morbidity in these settings. Epidemiological data from high-income countries have demonstrated a potent predictive association between self-reported stroke symptoms and risks of future strokes, incident cognitive impairment and all-cause mortality. OBJECTIVE To utilize a pictographic version of the 8-item Questionnaire for Verifying Stroke Free Status (QVSFS) to screen for stroke symptoms and determine its predictors among hypertensive and diabetic patients in a rural hospital within a LMIC. METHODS Between July and October 2016, 500 consecutive patients with hypertension and/or diabetes mellitus encountered in clinic at the Agogo Presbyterian Hospital, a district level health institution in Ghana were enrolled. A validated pictographic version of the QVSFS was administered by trained research assistants to all study participants and demographic and clinical information on hypertension and diabetes control were collected. The neurologist/specialist physician examined all patients neurologically using a structured questionnaire and reviewed medical charts for objective documentary evidence of stroke. Predictors of stroke symptoms were assessed using a multivariate logistic regression model. RESULTS Among the cohort, median (IQR) age was 58 (51-66) years, 399 (79.8%) were women, 388 (77.6%) had hypertension, 92 (18.4%) had diabetes and hypertension, and 20 (4.0%) had just diabetes. 30 (6.0%) patients had confirmed stroke/TIA after physician evaluation, 151 (30.6%) had at least one symptom of stroke (SS) without prior diagnosis of stroke/TIA and 319 (63.8%) reported no stroke symptoms. Independent predictors of reporting stroke symptoms were increasing age - aOR: 1.38 (1.16-1.64) for each 10years older and HBA1C-OR: 1.74 (1.16-2.61) for each 2% increase. Subjects with previous stroke/TIA diagnosis had significantly higher mean±SD systolic blood pressure (148.0±21.2mmHg vs. 136.0±17.3mmHg vs. 138.3±19.7mmHg, p=0.009) and median (IQR) HBA1C (8.8% (6.7-10.2) vs. 8.2 (6.4-10.6) vs. 7.2 (6.3-8.0), p=0.05) compared with SS and asymptomatic groups. CONCLUSION One in three patients with hypertension and/diabetes in rural Ghana report stroke-like symptoms. Routine use of the pictographic version of the QVSFS could assist in identifying patients with or at high risk for stroke who may benefit from appropriate prevention treatments.
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Affiliation(s)
- Fred S Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
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14
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Appelros P, Háls Berglund M, Ström JO. Long-Term Risk of Stroke after Transient Ischemic Attack. Cerebrovasc Dis 2016; 43:25-30. [DOI: 10.1159/000451061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 09/15/2016] [Indexed: 11/19/2022] Open
Abstract
Background: In the absence of active management, the stroke risk after a transient ischemic attack (TIA) may be high. Almost 10 years ago, the results of the EXPRESS and SOS-TIA studies called for a more rapid management of TIA patients. The purpose of this study was to investigate the other stroke risks in the longer term, after the implementation of a more active approach to TIA. We also wanted to assess the predictive value of the ABCD2 score in this context. Methods: Riksstroke is the national stroke registry in Sweden. Data from Riksstroke's TIA module, and the national cause-of-death register, for the years 2011 and 2012 were used in this study. Stroke occurrence was monitored via Riksstroke. Cox's regression was used for risk evaluation. The predictive value of the ABCD2 score was assessed by calculating the area under the receiver operating characteristics curve. Results: A total of 15,068 TIA episodes occurred in 14,102 patients. The follow-up time varied between 0 and 819 days, with an average of 417 days. The mortality for all TIA patients during the follow-up time was 7.1%. Of the unique patients, 545 had one or more strokes (3.9%), corresponding to 34 events per 1,000 person years. Significant risk factors for stroke were: age, previous TIA, atrial fibrillation (AF), oral anticoagulant (OAC) treatment, hypertension treatment, and the ABCD2 items speech impairment, unilateral weakness, and diabetes mellitus. The ABCD2 score correlated with a subsequent stroke, but its predictive value was low. Conclusion: The risk of stroke is low after the acute phase of a TIA, probably lower than in previous studies. This may be due to better secondary prevention in recent years. Several risk factors predict stroke, notably hypertensive treatment, which may be inadequate; and AF, where OACs may be under-used. It is difficult to identify the role of the ABCD2 score in clinical practice.
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15
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Cutting S, Regan E, Lee VH, Prabhakaran S. High ABCD2 Scores and In-Hospital Interventions following Transient Ischemic Attack. Cerebrovasc Dis Extra 2016; 6:76-83. [PMID: 27721312 PMCID: PMC5091225 DOI: 10.1159/000450692] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/07/2016] [Indexed: 12/26/2022] Open
Abstract
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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Affiliation(s)
- Shawna Cutting
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Ill., USA
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Ramirez L, Kim-Tenser MA, Sanossian N, Cen S, Wen G, He S, Mack WJ, Towfighi A. Trends in Transient Ischemic Attack Hospitalizations in the United States. J Am Heart Assoc 2016; 5:JAHA.116.004026. [PMID: 27664805 PMCID: PMC5079046 DOI: 10.1161/jaha.116.004026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Transient ischemic attack (TIA) is a major predictor of subsequent stroke. No study has assessed nation‐wide trends in hospitalization for TIA in the United States. Methods and Results Temporal trends in hospitalization for TIA (International Classification of Diseases, Ninth Revision code 435.0–435.9) from 2000 to 2010 were assessed among adults aged ≥25 years using the Nationwide Inpatient Sample. Age‐, sex‐, and race/ethnic‐specific TIA hospitalization rates were calculated using the weighted number of hospitalizations as the numerator and the US population as the denominator. Age‐adjusted rates were standardized to the 2000 US Census population. From 2000 to 2010, age‐adjusted TIA hospitalization rates decreased from 118 to 83 per 100 000 (overall rate reduction, −29.7%). Age‐specific TIA hospitalization rates increased for individuals aged 24 to 44 years (10–11 per 100 000), but decreased for individuals aged 45 to 64 (74 to 65 per 100 000), 65 to 84 (398 to 245 per 100 000), and ≥85 years (900 to 619 per 100 000). Blacks had the highest age‐adjusted yearly hospitalization rates, followed by Hispanics and whites (124, 82, and 67 per 100 000 in 2010). Rates slightly increased for blacks, but decreased for Hispanics and whites. Compared to women, age‐adjusted TIA hospitalization rates were lower and declined more steeply in men (132 to 89 per 100 000 versus 134 to 97 per 100 000). Conclusions Although overall TIA hospitalizations have decreased in the United States, the reduction has been more pronounced among older individuals, men, whites, and Hispanics. These findings highlight the need to target risk‐factor control among women, blacks, and individuals aged <45 years.
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Affiliation(s)
- Lucas Ramirez
- Keck School of Medicine, University of Southern California, Los Angeles, CA Department of Neurology, University of Southern California, Los Angeles, CA
| | - May A Kim-Tenser
- Keck School of Medicine, University of Southern California, Los Angeles, CA Department of Neurosurgery, University of Southern California, Los Angeles, CA Roxanna Todd Hodges Comprehensive Stroke Clinic, University of Southern California, Los Angeles, CA
| | - Nerses Sanossian
- Keck School of Medicine, University of Southern California, Los Angeles, CA Department of Neurosurgery, University of Southern California, Los Angeles, CA Roxanna Todd Hodges Comprehensive Stroke Clinic, University of Southern California, Los Angeles, CA Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA
| | - Steven Cen
- Keck School of Medicine, University of Southern California, Los Angeles, CA Department of Neurology, University of Southern California, Los Angeles, CA Department of Neurosurgery, University of Southern California, Los Angeles, CA Roxanna Todd Hodges Comprehensive Stroke Clinic, University of Southern California, Los Angeles, CA
| | - Ge Wen
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Shuhan He
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - William J Mack
- Keck School of Medicine, University of Southern California, Los Angeles, CA Department of Neurosurgery, University of Southern California, Los Angeles, CA Roxanna Todd Hodges Comprehensive Stroke Clinic, University of Southern California, Los Angeles, CA
| | - Amytis Towfighi
- Keck School of Medicine, University of Southern California, Los Angeles, CA Department of Neurology, University of Southern California, Los Angeles, CA Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA
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17
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O'Brien EC, Zhao X, Fonarow GC, Schulte PJ, Dai D, Smith EE, Schwamm LH, Bhatt DL, Xian Y, Saver JL, Reeves MJ, Peterson ED, Hernandez AF. Quality of Care and Ischemic Stroke Risk After Hospitalization for Transient Ischemic Attack: Findings From Get With The Guidelines-Stroke. CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES 2016; 8:S117-24. [PMID: 26515199 DOI: 10.1161/circoutcomes.115.002048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with transient ischemic attack (TIA) are at increased risk for ischemic stroke. We derived a prediction rule for 1-year ischemic stroke risk post-TIA, examining estimated risk, receipt of inpatient quality of care measures for TIA, and the presence or absence of stroke at 1 year post discharge. METHODS AND RESULTS We linked 67 892 TIA Get With The Guidelines-Stroke patients >65 years (2003-2008) to Medicare inpatient claims to obtain longitudinal outcomes. Using Cox proportional hazards modeling in a split sample, we identified baseline demographics and clinical characteristics associated with ischemic stroke admission during the year post-TIA, and developed a Get With The Guidelines Ischemic Stroke after TIA Risk Score; performance was examined in the validation sample. Quality of care was estimated by a global defect-free care measure, and individual performance measures within estimated risk score quintiles. The overall hospital admission rate for ischemic stroke during the year post-TIA was 5.7%. Patients with ischemic stroke were more likely to be older, black, and have higher rates of smoking, previous stroke, diabetes mellitus, previous myocardial infarction, heart failure, and atrial fibrillation. The Risk Score showed moderate discriminative performance (c-statistic=0.606); highest quintile patients were less likely to receive statins, smoking cessation counseling, and defect-free care. Although not associated with 1-year ischemic stroke, DCF was associated with a significantly lower risk of all-cause mortality. CONCLUSIONS TIA patients with high estimated ischemic stroke risk are less likely to receive defect-free care than low-risk patients. Standardized risk assessment and delivery of optimal inpatient care are needed to reduce this risk-treatment mismatch.
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Affiliation(s)
- Emily C O'Brien
- From the Duke Clinical Research Institute, Department of Medicine, Durham, NC (E.C.O.B., X.Z., P.J.S., D.D., Y.X., E.D.P., A.F.H.); Department of Medicine, Ronald-Reagan UCLA Medical Center, Los Angeles, CA (G.C.F., J.L.S.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (L.H.S.); Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Department of Epidemiology, Michigan State University, East Lansing (M.J.R.).
| | - Xin Zhao
- From the Duke Clinical Research Institute, Department of Medicine, Durham, NC (E.C.O.B., X.Z., P.J.S., D.D., Y.X., E.D.P., A.F.H.); Department of Medicine, Ronald-Reagan UCLA Medical Center, Los Angeles, CA (G.C.F., J.L.S.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (L.H.S.); Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Department of Epidemiology, Michigan State University, East Lansing (M.J.R.)
| | - Gregg C Fonarow
- From the Duke Clinical Research Institute, Department of Medicine, Durham, NC (E.C.O.B., X.Z., P.J.S., D.D., Y.X., E.D.P., A.F.H.); Department of Medicine, Ronald-Reagan UCLA Medical Center, Los Angeles, CA (G.C.F., J.L.S.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (L.H.S.); Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Department of Epidemiology, Michigan State University, East Lansing (M.J.R.)
| | - Phillip J Schulte
- From the Duke Clinical Research Institute, Department of Medicine, Durham, NC (E.C.O.B., X.Z., P.J.S., D.D., Y.X., E.D.P., A.F.H.); Department of Medicine, Ronald-Reagan UCLA Medical Center, Los Angeles, CA (G.C.F., J.L.S.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (L.H.S.); Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Department of Epidemiology, Michigan State University, East Lansing (M.J.R.)
| | - David Dai
- From the Duke Clinical Research Institute, Department of Medicine, Durham, NC (E.C.O.B., X.Z., P.J.S., D.D., Y.X., E.D.P., A.F.H.); Department of Medicine, Ronald-Reagan UCLA Medical Center, Los Angeles, CA (G.C.F., J.L.S.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (L.H.S.); Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Department of Epidemiology, Michigan State University, East Lansing (M.J.R.)
| | - Eric E Smith
- From the Duke Clinical Research Institute, Department of Medicine, Durham, NC (E.C.O.B., X.Z., P.J.S., D.D., Y.X., E.D.P., A.F.H.); Department of Medicine, Ronald-Reagan UCLA Medical Center, Los Angeles, CA (G.C.F., J.L.S.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (L.H.S.); Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Department of Epidemiology, Michigan State University, East Lansing (M.J.R.)
| | - Lee H Schwamm
- From the Duke Clinical Research Institute, Department of Medicine, Durham, NC (E.C.O.B., X.Z., P.J.S., D.D., Y.X., E.D.P., A.F.H.); Department of Medicine, Ronald-Reagan UCLA Medical Center, Los Angeles, CA (G.C.F., J.L.S.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (L.H.S.); Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Department of Epidemiology, Michigan State University, East Lansing (M.J.R.)
| | - Deepak L Bhatt
- From the Duke Clinical Research Institute, Department of Medicine, Durham, NC (E.C.O.B., X.Z., P.J.S., D.D., Y.X., E.D.P., A.F.H.); Department of Medicine, Ronald-Reagan UCLA Medical Center, Los Angeles, CA (G.C.F., J.L.S.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (L.H.S.); Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Department of Epidemiology, Michigan State University, East Lansing (M.J.R.)
| | - Ying Xian
- From the Duke Clinical Research Institute, Department of Medicine, Durham, NC (E.C.O.B., X.Z., P.J.S., D.D., Y.X., E.D.P., A.F.H.); Department of Medicine, Ronald-Reagan UCLA Medical Center, Los Angeles, CA (G.C.F., J.L.S.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (L.H.S.); Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Department of Epidemiology, Michigan State University, East Lansing (M.J.R.)
| | - Jeffrey L Saver
- From the Duke Clinical Research Institute, Department of Medicine, Durham, NC (E.C.O.B., X.Z., P.J.S., D.D., Y.X., E.D.P., A.F.H.); Department of Medicine, Ronald-Reagan UCLA Medical Center, Los Angeles, CA (G.C.F., J.L.S.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (L.H.S.); Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Department of Epidemiology, Michigan State University, East Lansing (M.J.R.)
| | - Mathew J Reeves
- From the Duke Clinical Research Institute, Department of Medicine, Durham, NC (E.C.O.B., X.Z., P.J.S., D.D., Y.X., E.D.P., A.F.H.); Department of Medicine, Ronald-Reagan UCLA Medical Center, Los Angeles, CA (G.C.F., J.L.S.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (L.H.S.); Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Department of Epidemiology, Michigan State University, East Lansing (M.J.R.)
| | - Eric D Peterson
- From the Duke Clinical Research Institute, Department of Medicine, Durham, NC (E.C.O.B., X.Z., P.J.S., D.D., Y.X., E.D.P., A.F.H.); Department of Medicine, Ronald-Reagan UCLA Medical Center, Los Angeles, CA (G.C.F., J.L.S.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (L.H.S.); Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Department of Epidemiology, Michigan State University, East Lansing (M.J.R.)
| | - Adrian F Hernandez
- From the Duke Clinical Research Institute, Department of Medicine, Durham, NC (E.C.O.B., X.Z., P.J.S., D.D., Y.X., E.D.P., A.F.H.); Department of Medicine, Ronald-Reagan UCLA Medical Center, Los Angeles, CA (G.C.F., J.L.S.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (L.H.S.); Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and Department of Epidemiology, Michigan State University, East Lansing (M.J.R.)
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Crowfoot GM, van der Riet PJ, Maguire JM. Living within stories: Exploring the experiences of people with transient ischemic attack. Nurs Health Sci 2016; 18:52-7. [DOI: 10.1111/nhs.12227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 04/14/2015] [Accepted: 04/14/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Gary Mitchell Crowfoot
- School of Nursing and Midwifery; Faculty of Health and Medicine; University of Newcastle; Newcastle New South Wales Australia
| | - Pamela Jane van der Riet
- School of Nursing and Midwifery; Faculty of Health and Medicine; University of Newcastle; Newcastle New South Wales Australia
| | - Jane Margaret Maguire
- School of Nursing and Midwifery; Faculty of Health and Medicine; University of Newcastle; Newcastle New South Wales Australia
- Priority Research Centre for Translational Neuroscience and Mental Health; Hunter Medical Research Institute; Newcastle New South Wales Australia
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Saeed F, Adil MM, Vidal GA, Piracha BH, Nahab F, Salam Khan A, Navaneethan SD. Outcomes of transient ischemic attack in maintenance dialysis patients and those with chronic kidney disease. Nephrol Dial Transplant 2016; 31:128-32. [DOI: 10.1093/ndt/gfv246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 05/13/2015] [Indexed: 11/14/2022] Open
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Li OL, Silver FL, Lichtman J, Fang J, Stamplecoski M, Wengle RS, Kapral MK. Sex Differences in the Presentation, Care, and Outcomes of Transient Ischemic Attack: Results From the Ontario Stroke Registry. Stroke 2015; 47:255-7. [PMID: 26556821 DOI: 10.1161/strokeaha.115.010485] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/08/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Little is known about whether sex differences exist in the presentation, management, and outcomes of transient ischemic attack. METHODS We conducted a cohort study of 5991 consecutive patients with transient ischemic attack admitted to 11 stroke centers in Ontario, Canada, between July 1, 2003, and March 31, 2008 and compared presenting symptoms, processes of care, and outcomes in women and men. We used linkages to administrative databases to evaluate mortality and recurrent vascular events within 30 days and 1 year of the initial presentation, with multivariable analyses to assess whether sex differences persisted after adjustment for age and comorbid conditions. RESULTS The most common presenting symptoms for both sexes were weakness, speech impairment, and sensory deficit, with headache being slightly more frequent in women. Women were less likely than men to undergo carotid imaging, carotid endarterectomy, or receive lipid-lowering therapy. One-year mortality was slightly lower in women than in men (adjusted hazard ratio, 0.77; 95% confidence interval, 0.63-0.94). CONCLUSIONS We found only minor sex differences in the presentation and management of transient ischemic attack, suggesting that current public awareness campaigns focusing on classic warning signs are appropriate for both women and men. Future work should focus on evaluating whether lower rates of carotid imaging, endarterectomy, and lipid-lowering therapy in women reflect undertreatment of women or are appropriate based on patient eligibility.
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Affiliation(s)
- Olivia L Li
- From the Department of Medicine, University of Toronto, Ontario, Canada (O.L.L., F.L.S., R.S.W., M.K.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (F.L.S., J.F., M.S., M.K.K.)
| | - Frank L Silver
- From the Department of Medicine, University of Toronto, Ontario, Canada (O.L.L., F.L.S., R.S.W., M.K.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (F.L.S., J.F., M.S., M.K.K.)
| | - Judith Lichtman
- From the Department of Medicine, University of Toronto, Ontario, Canada (O.L.L., F.L.S., R.S.W., M.K.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (F.L.S., J.F., M.S., M.K.K.)
| | - Jiming Fang
- From the Department of Medicine, University of Toronto, Ontario, Canada (O.L.L., F.L.S., R.S.W., M.K.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (F.L.S., J.F., M.S., M.K.K.)
| | - Melissa Stamplecoski
- From the Department of Medicine, University of Toronto, Ontario, Canada (O.L.L., F.L.S., R.S.W., M.K.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (F.L.S., J.F., M.S., M.K.K.)
| | - Rebecca S Wengle
- From the Department of Medicine, University of Toronto, Ontario, Canada (O.L.L., F.L.S., R.S.W., M.K.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (F.L.S., J.F., M.S., M.K.K.)
| | - Moira K Kapral
- From the Department of Medicine, University of Toronto, Ontario, Canada (O.L.L., F.L.S., R.S.W., M.K.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (F.L.S., J.F., M.S., M.K.K.)
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21
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Charmoille E, Brizzi V, Lepidi S, Sassoust G, Roullet S, Ducasse E, Midy D, Bérard X. Thirty-day outcome of delayed versus early management of symptomatic carotid stenosis. Ann Vasc Surg 2015; 29:977-84. [PMID: 25765637 DOI: 10.1016/j.avsg.2015.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/09/2015] [Accepted: 01/10/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of this study was to compare outcomes of early (<15 days) versus delayed carotid endarterectomy (CEA) in symptomatic patients. METHODS All CEA procedures performed for symptomatic carotid stenosis between January 2006 and May 2010 were retrospectively reviewed. Postoperative mortality (within 30 days), stroke, and myocardial infarction (MI) rates were analyzed in the early and delayed CEA groups. RESULTS During the study period, 149 patients were included. Carotid revascularization was performed within 15 days after symptom onset in 62 (41.6%) patients and longer than 15 days after symptom onset in 87 (58.4%) patients. The mean time lapse between onset of neurological symptoms and surgery was 9.3 days (range 1-15) in the early surgery group and 47.9 days (range 16-157) in the delayed surgery group. Thirty-day combined stroke and death rates were, respectively, 1.7% and 3.5% in the early and the delayed surgery groups. Thirty-day combined stroke, death, and MI rates were, respectively, 1.7% and 5.9% in the early and the delayed surgery groups. CONCLUSION During the study period, the reduction of the symptom-to-knife time in application to the carotid revascularization guidelines did not impact our outcomes suggesting that early CEA achieves 30-day mortality and morbidity rates at least equivalent to those of delayed CEA.
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Affiliation(s)
- Emilie Charmoille
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France; Bordeaux University, Bordeaux, France
| | - Vincenzo Brizzi
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France.
| | - Sandro Lepidi
- Vascular Surgery Department, Padova University Hospital, Padova, Italy
| | - Gérard Sassoust
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France
| | - Stéphanie Roullet
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France
| | - Eric Ducasse
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France; Bordeaux University, Bordeaux, France
| | - Dominique Midy
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France; Bordeaux University, Bordeaux, France
| | - Xavier Bérard
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France; Bordeaux University, Bordeaux, France
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Wasserman JK, Perry JJ, Sivilotti ML, Sutherland J, Worster A, Émond M, Jin AY, Oczkowski WJ, Sahlas DJ, Murray H, MacKey A, Verreault S, Wells GA, Dowlatshahi D, Stotts G, Stiell IG, Sharma M. Computed Tomography Identifies Patients at High Risk for Stroke After Transient Ischemic Attack/Nondisabling Stroke. Stroke 2015; 46:114-9. [DOI: 10.1161/strokeaha.114.006768] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Ischemia on computed tomography (CT) is associated with subsequent stroke after transient ischemic attack. This study assessed CT findings of acute ischemia, chronic ischemia, or microangiopathy for predicting subsequent stroke after transient ischemic attack.
Methods—
This prospective cohort study enrolled patients with transient ischemic attack or nondisabling stroke that had CT scanning within 24 hours. Primary outcome was subsequent stroke within 90 days. Secondary outcomes were stroke at ≤2 or >2 days. CT findings were classified as ischemia present or absent and acute or chronic or microangiopathy. Analysis used Fisher exact test and multivariate logistic regression.
Results—
A total of 2028 patients were included; 814 had ischemic changes on CT. Subsequent stroke rate was 3.4% at 90 days and 1.5% at ≤2 days. Stroke risk was greater if baseline CT showed acute ischemia alone (10.6%;
P
=0.002), acute+chronic ischemia (17.4%;
P
=0.007), acute ischemia+microangiopathy (17.6%;
P
=0.019), or acute+chronic ischemia+microangiopathy (25.0%;
P
=0.029). Logistic regression found acute ischemia alone (odds ratio [OR], 2.61; 95% confidence interval [CI[, 1.22–5.57), acute+chronic ischemia (OR, 5.35; 95% CI, 1.71–16.70), acute ischemia+microangiopathy (OR, 4.90; 95% CI, 1.33–18.07), or acute+chronic ischemia+microangiopathy (OR, 8.04; 95% CI, 1.52–42.63) was associated with a greater risk at 90 days, whereas acute+chronic ischemia (OR, 10.78; 95% CI, 2.93–36.68), acute ischemia+microangiopathy (OR, 8.90; 95% CI, 1.90–41.60), and acute+chronic ischemia+microangiopathy (OR, 23.66; 95% CI, 4.34–129.03) had greater risk at ≤2 days. Only acute ischemia (OR, 2.70; 95% CI, 1.01–7.18;
P
=0.047) was associated with a greater risk at >2 days.
Conclusions—
In patients with transient ischemic attack/nondisabling stroke, CT evidence of acute ischemia alone or acute ischemia with chronic ischemia or microangiopathy was associated with increased subsequent stroke risk within 90 days.
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Affiliation(s)
- Jason K. Wasserman
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Jeffrey J. Perry
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Marco L.A. Sivilotti
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Jane Sutherland
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Andrew Worster
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Marcel Émond
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Albert Y. Jin
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Wieslaw J. Oczkowski
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Demetrios J. Sahlas
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Heather Murray
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Ariane MacKey
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Steve Verreault
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - George A. Wells
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Dar Dowlatshahi
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Grant Stotts
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Ian G. Stiell
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
| | - Mukul Sharma
- From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.),
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23
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Wardlaw J, Brazzelli M, Miranda H, Chappell F, McNamee P, Scotland G, Quayyum Z, Martin D, Shuler K, Sandercock P, Dennis M. An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke: a systematic review, meta-analysis and economic evaluation. Health Technol Assess 2014; 18:1-368, v-vi. [PMID: 24791949 DOI: 10.3310/hta18270] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Patients with transient ischaemic attack (TIA) or minor stroke need rapid treatment of risk factors to prevent recurrent stroke. ABCD2 score or magnetic resonance diffusion-weighted brain imaging (MR DWI) may help assessment and treatment. OBJECTIVES Is MR with DWI cost-effective in stroke prevention compared with computed tomography (CT) brain scanning in all patients, in specific subgroups or as 'one-stop' brain-carotid imaging? What is the current UK availability of services for stroke prevention? DATA SOURCES Published literature; stroke registries, audit and randomised clinical trials; national databases; survey of UK clinical and imaging services for stroke; expert opinion. REVIEW METHODS Systematic reviews and meta-analyses of published/unpublished data. Decision-analytic model of stroke prevention including on a 20-year time horizon including nine representative imaging scenarios. RESULTS The pooled recurrent stroke rate after TIA (53 studies, 30,558 patients) is 5.2% [95% confidence interval (CI) 3.9% to 5.9%] by 7 days, and 6.7% (5.2% to 8.7%) at 90 days. ABCD2 score does not identify patients with key stroke causes or identify mimics: 66% of specialist-diagnosed true TIAs and 35-41% of mimics had an ABCD2 score of ≥ 4; 20% of true TIAs with ABCD2 score of < 4 had key risk factors. MR DWI (45 studies, 9078 patients) showed an acute ischaemic lesion in 34.3% (95% CI 30.5% to 38.4%) of TIA, 69% of minor stroke patients, i.e. two-thirds of TIA patients are DWI negative. TIA mimics (16 studies, 14,542 patients) make up 40-45% of patients attending clinics. UK survey (45% response) showed most secondary prevention started prior to clinic, 85% of primary brain imaging was same-day CT; 51-54% of patients had MR, mostly additional to CT, on average 1 week later; 55% omitted blood-sensitive MR sequences. Compared with 'CT scan all patients' MR was more expensive and no more cost-effective, except for patients presenting at > 1 week after symptoms to diagnose haemorrhage; strategies that triaged patients with low ABCD2 scores for slow investigation or treated DWI-negative patients as non-TIA/minor stroke prevented fewer strokes and increased costs. 'One-stop' CT/MR angiographic-plus-brain imaging was not cost-effective. LIMITATIONS Data on sensitivity/specificity of MR in TIA/minor stroke, stroke costs, prognosis of TIA mimics and accuracy of ABCD2 score by non-specialists are sparse or absent; all analysis had substantial heterogeneity. CONCLUSIONS Magnetic resonance with DWI is not cost-effective for secondary stroke prevention. MR was most helpful in patients presenting at > 1 week after symptoms if blood-sensitive sequences were used. ABCD2 score is unlikely to facilitate patient triage by non-stroke specialists. Rapid specialist assessment, CT brain scanning and identification of serious underlying stroke causes is the most cost-effective stroke prevention strategy. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Joanna Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Miriam Brazzelli
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Hector Miranda
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Francesca Chappell
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Paul McNamee
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graham Scotland
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Zahid Quayyum
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Duncan Martin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kirsten Shuler
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Peter Sandercock
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Martin Dennis
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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24
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Purroy F, Jiménez Caballero PE, Gorospe A, Torres MJ, Alvarez-Sabin J, Martínez-Sánchez P, Cánovas D, Freijo M, Egido JA, Ramírez-Moreno JM, Alonso-Arias A, Rodríguez-Campello A, Casado-Naranjo I, Martí-Fàbregas J, Silva Y, Cardona P, Morales A, García-Pastor A, Arenillas JF, Segura T, Jiménez C, Masjuán J. How predictors and patterns of stroke recurrence after a TIA differ during the first year of follow-up. J Neurol 2014; 261:1614-21. [PMID: 24912470 DOI: 10.1007/s00415-014-7390-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/24/2014] [Accepted: 05/26/2014] [Indexed: 01/31/2023]
Abstract
The highest risk of subsequent stroke after a TIA occurs within the first week after the index event. However, the risk of stroke recurrence (SR) remains high during the first year of follow-up. We studied the temporal pattern and predictors of SR (at 7 days and from 7 days to 1-year follow-up). Between April 2008 and December 2009, we included 1,255 consecutive TIA patients from 30 Spanish stroke centers (PROMAPA study). We determined the short-term (at 7 days) and long-term (from 8 days to 1 year) risk of SR. Patients who underwent short-term recurrence and long-term recurrence were compared with regard to clinical findings, vascular territories, and etiology. Enough information (clinical variables and extracranial vascular imaging) was assessed in 1,137 (90.6 %) patients. The 7-day stroke risk was 2.6 %. 32 (3.0 %) patients had an SR after 7-day follow-up. Multiple TIA (HR 3.50, 1.67-7.35, p = 0.001) and large artery atherosclerosis (HR 2.51, 1.17-5.37, p = 0.018) were independent predictors of early SR, whereas previous stroke (HR 1.40, 1.03-1.92, p = 0.034) and coronary heart disease (2.65, 1.28-5.50, p = 0.009) were independent predictors of late SR. Notoriously, 80 % of SR happened in the same territory of the index TIA at 7-day follow-up, whereas only 38 % during the long-term follow-up (p < 0.001). Different predictors of SR were identified throughout the follow-up period. Moreover, the ischemic mechanism differed in early and late stroke recurrences.
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Affiliation(s)
- F Purroy
- Stroke Unit, Department of Neurology, IRBLLEIDA Research Institute, Hospital Universitari Arnau de Vilanova de Lleida, Universitat de Lleida, Avda Rovira Roure, 80, 25198, Lleida, Spain,
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25
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Kerber KA, Zahuranec DB, Brown DL, Meurer WJ, Burke JF, Smith MA, Lisabeth LD, Fendrick AM, McLaughlin T, Morgenstern LB. Stroke risk after nonstroke emergency department dizziness presentations: a population-based cohort study. Ann Neurol 2014; 75:899-907. [PMID: 24788511 DOI: 10.1002/ana.24172] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 04/26/2014] [Accepted: 04/27/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Acute stroke is a serious concern in emergency department (ED) dizziness presentations. Prior studies, however, suggest that stroke is actually an unlikely cause of these presentations. Lacking are data on short- and long-term follow-up from population-based studies to establish stroke risk after presumed nonstroke ED dizziness presentations. METHODS From May 8, 2011 to May 7, 2012, patients ≥45 years of age presenting to EDs in Nueces County, Texas, with dizziness, vertigo, or imbalance were identified, excluding those with stroke as the initial diagnosis. Stroke events after the ED presentation up to October 2, 2012 were determined using the BASIC (Brain Attack Surveillance in Corpus Christi) study, which uses rigorous surveillance and neurologist validation. Cumulative stroke risk was calculated using Kaplan-Meier estimates. RESULTS A total of 1,245 patients were followed for a median of 347 days (interquartile range [IQR] = 230-436 days). Median age was 61.9 years (IQR = 53.8-74.0 years). After the ED visit, 15 patients (1.2%) had a stroke. Stroke risk was 0.48% (95% confidence interval [CI] = 0.22-1.07%) at 2 days, 0.48% (95% CI = 0.22-1.07%) at 7 days, 0.56% (95% CI = 0.27-1.18%) at 30 days, 0.56% (95% CI = 0.27-1.18%) at 90 days, and 1.42% (95% CI = 0.85-2.36%) at 12 months. INTERPRETATION Using rigorous case ascertainment and outcome assessment in a population-based design, we found that the risk of stroke after presumed nonstroke ED dizziness presentations is very low, supporting a nonstroke etiology to the overwhelming majority of original events. High-risk subgroups likely exist, however, because most of the 90-day stroke risk occurred within 2 days. Vascular risk stratification was insufficient to identify these cases.
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Affiliation(s)
- Kevin A Kerber
- Department of Neurology University of Michigan Health System, Ann Arbor, MI; Stroke Program, University of Michigan Health System, Ann Arbor, MI
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Kiyohara T, Kamouchi M, Kumai Y, Ninomiya T, Hata J, Yoshimura S, Ago T, Okada Y, Kitazono T, Ishitsuka T, Fujimoto S, Ibayashi S, Kusuda K, Arakawa S, Tamaki K, Sadoshima S, Irie K, Fujii K, Okada Y, Yasaka M, Nagao T, Ooboshi H, Omae T, Toyoda K, Nakane H, Sugimori H, Fukuda K, Matsuo R, Kuroda J, Fukushima Y. ABCD3 and ABCD3-I Scores Are Superior to ABCD2 Score in the Prediction of Short- and Long-Term Risks of Stroke After Transient Ischemic Attack. Stroke 2014; 45:418-25. [DOI: 10.1161/strokeaha.113.003077] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Takuya Kiyohara
- From the Departments of Medicine and Clinical Science (T. Kiyohara, Y.K., T.N., J.H., S.Y., T.A., T. Kitazono), Health Care Administration and Management (M.K.), and Environmental Medicine (T.N., J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology, Kyushu University Hospital, Fukuoka, Japan (M.K., T.A., T. Kitazono); Department of Cerebrovascular Disease and Neurology, Hakujyuji Hospital, Fukuoka, Japan (Y.K.)
| | - Masahiro Kamouchi
- From the Departments of Medicine and Clinical Science (T. Kiyohara, Y.K., T.N., J.H., S.Y., T.A., T. Kitazono), Health Care Administration and Management (M.K.), and Environmental Medicine (T.N., J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology, Kyushu University Hospital, Fukuoka, Japan (M.K., T.A., T. Kitazono); Department of Cerebrovascular Disease and Neurology, Hakujyuji Hospital, Fukuoka, Japan (Y.K.)
| | - Yasuhiro Kumai
- From the Departments of Medicine and Clinical Science (T. Kiyohara, Y.K., T.N., J.H., S.Y., T.A., T. Kitazono), Health Care Administration and Management (M.K.), and Environmental Medicine (T.N., J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology, Kyushu University Hospital, Fukuoka, Japan (M.K., T.A., T. Kitazono); Department of Cerebrovascular Disease and Neurology, Hakujyuji Hospital, Fukuoka, Japan (Y.K.)
| | - Toshiharu Ninomiya
- From the Departments of Medicine and Clinical Science (T. Kiyohara, Y.K., T.N., J.H., S.Y., T.A., T. Kitazono), Health Care Administration and Management (M.K.), and Environmental Medicine (T.N., J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology, Kyushu University Hospital, Fukuoka, Japan (M.K., T.A., T. Kitazono); Department of Cerebrovascular Disease and Neurology, Hakujyuji Hospital, Fukuoka, Japan (Y.K.)
| | - Jun Hata
- From the Departments of Medicine and Clinical Science (T. Kiyohara, Y.K., T.N., J.H., S.Y., T.A., T. Kitazono), Health Care Administration and Management (M.K.), and Environmental Medicine (T.N., J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology, Kyushu University Hospital, Fukuoka, Japan (M.K., T.A., T. Kitazono); Department of Cerebrovascular Disease and Neurology, Hakujyuji Hospital, Fukuoka, Japan (Y.K.)
| | - Sohei Yoshimura
- From the Departments of Medicine and Clinical Science (T. Kiyohara, Y.K., T.N., J.H., S.Y., T.A., T. Kitazono), Health Care Administration and Management (M.K.), and Environmental Medicine (T.N., J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology, Kyushu University Hospital, Fukuoka, Japan (M.K., T.A., T. Kitazono); Department of Cerebrovascular Disease and Neurology, Hakujyuji Hospital, Fukuoka, Japan (Y.K.)
| | - Tetsuro Ago
- From the Departments of Medicine and Clinical Science (T. Kiyohara, Y.K., T.N., J.H., S.Y., T.A., T. Kitazono), Health Care Administration and Management (M.K.), and Environmental Medicine (T.N., J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology, Kyushu University Hospital, Fukuoka, Japan (M.K., T.A., T. Kitazono); Department of Cerebrovascular Disease and Neurology, Hakujyuji Hospital, Fukuoka, Japan (Y.K.)
| | - Yasushi Okada
- From the Departments of Medicine and Clinical Science (T. Kiyohara, Y.K., T.N., J.H., S.Y., T.A., T. Kitazono), Health Care Administration and Management (M.K.), and Environmental Medicine (T.N., J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology, Kyushu University Hospital, Fukuoka, Japan (M.K., T.A., T. Kitazono); Department of Cerebrovascular Disease and Neurology, Hakujyuji Hospital, Fukuoka, Japan (Y.K.)
| | - Takanari Kitazono
- From the Departments of Medicine and Clinical Science (T. Kiyohara, Y.K., T.N., J.H., S.Y., T.A., T. Kitazono), Health Care Administration and Management (M.K.), and Environmental Medicine (T.N., J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology, Kyushu University Hospital, Fukuoka, Japan (M.K., T.A., T. Kitazono); Department of Cerebrovascular Disease and Neurology, Hakujyuji Hospital, Fukuoka, Japan (Y.K.)
| | | | | | | | | | - Shuji Arakawa
- Japan Labour Health and Welfare Organization Kyushu Rosai Hospital
| | | | | | | | | | - Yasushi Okada
- National Hospital Organization Kyushu Medical Center
| | | | | | | | | | | | - Hiroshi Nakane
- National Hospital Organization Fukuoka-Higashi Medical Center
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A Retrospective Study on Early Carotid Endarterectomy within 48 Hours after Transient Ischemic Attack and Stroke in Evolution. Ann Vasc Surg 2014; 28:227-38. [DOI: 10.1016/j.avsg.2013.02.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 02/09/2013] [Accepted: 02/11/2013] [Indexed: 11/20/2022]
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Abstract
Preconditioning (PC) describes a phenomenon whereby a sub-injury inducing stress can protect against a later injurious stress. Great strides have been made in identifying the mechanisms of PC-induced protection in animal models of brain injury. While these may help elucidate potential therapeutic targets, there are questions over the clinical utility of cerebral PC, primarily because of questions over the need to give the PC stimulus prior to the injury, narrow therapeutic windows and safety. The object of this review is to address the question of whether there may indeed be a clinical use for cerebral PC and to discuss the deficiencies in our knowledge of PC that may hamper such clinical translation.
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Lee SB, Huh PW, Kim DS, Yoo DS, Lee TG, Cho KS. Early superficial temporal artery to middle cerebral artery bypass in acute ischemic stroke. Clin Neurol Neurosurg 2013; 115:1238-44. [DOI: 10.1016/j.clineuro.2012.11.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 11/20/2012] [Accepted: 11/24/2012] [Indexed: 01/20/2023]
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Akiyama H, Hasegawa Y. Knowledge of transient ischemic attack among the Japanese. J Stroke Cerebrovasc Dis 2013; 22:457-64. [PMID: 23642755 DOI: 10.1016/j.jstrokecerebrovasdis.2013.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 03/07/2013] [Accepted: 03/12/2013] [Indexed: 10/26/2022] Open
Abstract
Stroke is often preceded by a transient ischemic attack (TIA). To properly recognize TIA and take prompt initial action, all citizens should be fully educated about TIA. Our objective is to evaluate how much knowledge of TIA has spread among Japanese citizens. As a preliminary study with this goal, we conducted an Internet-based questionnaire survey of 30,000 Japanese citizens aged 20 years or more, excluding health care professionals, from across Japan to investigate their awareness and knowledge of stroke and TIA. Valid responses were obtained from 11,121 Japanese citizens, aged 44.8 ± 13.1 (mean ± SD) years. The most frequent response pertaining to initial action at TIA onset was "visit the family doctor" (41.8%), followed by "immediately call an ambulance" (22.4%). Tokushima, Kagawa, and Kumamoto were the top 3 prefectures with the highest ambulance request rates. Factors contributing to immediately calling an ambulance were respondents' confidence about the involvement of stroke (odds ratio [OR] 2.290, 95% confidence interval [CI] 1.250-4.318, P = .009) and knowledge of the importance of initiating treatment within 3 hours of symptom onset (OR 2.273, 95% CI 1.923-2.825, P = .000). Although television was the primary source of information about stroke for all groups of age, older respondents obtained more information from newspapers than younger respondents. The results showed that many Japanese citizens would fail to call an ambulance in response to TIA, and diagnosis by a primary care physician appears to be the main triage system for the treatment of TIA. Rather than instituting a nationally uniform strategy of education for the promotion of TIA awareness among Japanese citizens, education programs should account for age-specific and regional differences among citizens.
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Affiliation(s)
- Hisanao Akiyama
- Department of Neurology, St Marianna University School of Medicine, Kanagawa, Japan.
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Olson DM, Cox M, Pan W, Sacco RL, Fonarow GC, Zorowitz R, Labresh KA, Schwamm LH, Williams L, Goldstein LB, Bushnell CD, Peterson ED. Death and rehospitalization after transient ischemic attack or acute ischemic stroke: one-year outcomes from the adherence evaluation of acute ischemic stroke-longitudinal registry. J Stroke Cerebrovasc Dis 2012; 22:e181-8. [PMID: 23273788 DOI: 10.1016/j.jstrokecerebrovasdis.2012.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 09/11/2012] [Accepted: 11/01/2012] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Longitudinal data directly comparing the rates of death and rehospitalization of patients discharged after transient ischemic attack (TIA) versus acute ischemic stroke (AIS) are lacking. METHODS Data were analyzed from 2802 patients (TIA n = 552; AIS n = 2250) admitted to 100 U.S. hospitals participating in the Get With The Guidelines-Stroke and the Adherence Evaluation of Acute Ischemic Stroke-Longitudinal registry. The primary composite outcome was the adjusted rate of all-cause death and rehospitalization over 1 year after discharge. Four additional single or combined outcomes were explored. RESULTS Compared with AIS, TIA patients were older (median 69 v 66 years; P = .007) and more likely female (53.3% v 44.2%; P < .0001). Secondary prevention medication use after hospital discharge was less intensive after TIA, with underuse for both conditions. All-cause death or rehospitalization at 1 year was similar for TIA and AIS patients (37.7% v 34.6%; P = .271); the frequency for TIA patients was higher after covariate adjustment (hazard ratio [HR] 1.19; 95% confidence interval [CI] 1.01-1.41). One-year all-cause mortality was similar among those with TIA compared to AIS patients (3.8% v 5.7%; P = .071; adjusted HR 0.86; 95% CI 0.52-1.42). All-cause rehospitalizations were higher for TIA compared to AIS patients (36.4% v 33.0%; P = .186; adjusted HR 1.20; 95% CI 1.02-1.42), but similar for stroke rehospitalizations (10.1% v 7.4%; P = .037; adjusted HR 1.38, 95% CI 0.997-1.92). CONCLUSIONS Patients with TIA have similar or worse 12-month postdischarge risk of death or rehospitalization as compared with those with AIS. Outcomes after TIA and AIS might be improved with better adherence to secondary preventive guidelines.
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Affiliation(s)
- Daiwai M Olson
- Department of Medicine, Duke Clinical Research Institute, Durham, NC, Durham, NC.
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Judd SE, Kleindorfer DO, McClure LA, Rhodes JD, Howard G, Cushman M, Howard VJ. Self-report of stroke, transient ischemic attack, or stroke symptoms and risk of future stroke in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Stroke 2012; 44:55-60. [PMID: 23233382 DOI: 10.1161/strokeaha.112.675033] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE History of stroke and transient ischemic attack (TIA) are documented risk factors for subsequent stroke and all-cause mortality. Recent reports suggest increased risk among those reporting stroke symptoms absent stroke or TIA. However, the relative magnitude of increased stroke risk has not been described across the symptomatic spectrum: (1) asymptomatic, (2) stroke symptoms (SS) only, (3) TIA, (4) distant stroke (DS), and (5) recent stroke (RS). METHODS Between 2003 and 2007, the REasons for Geographic And Racial Differences in Stroke (REGARDS) study enrolled 30 239 black and white Americans ≥45 years of age. DS and RS were defined as self-report of physician diagnosis of stroke >5 or <5 years before baseline, respectively. SS was defined as a history of any of 6 sudden onset stroke symptoms absent TIA/stroke diagnosis. Kaplan-Meier and proportional hazards analysis were used to contrast stroke risk differences. RESULTS Over 5.0±1.72 years of follow-up, 737 strokes were validated. Compared with asymptomatic persons, those with SS, TIA, DS, and RS all had increased risk of future stroke. After adjustment for age, race, sex, income, education, alcohol intake, current smoking, and a history of diabetes mellitus, hypertension, myocardial infarction, atrial fibrillation, and dyslipidemia, there was 1.20-fold (not statistically significant) increased stroke risk for SS (95% CI, 0.96-1.51), 1.73-fold for TIA (95% CI, 1.27-2.36), 2.23-fold for DS (95% CI, 1.61- 3.09), and 2.85-fold for RS (95% CI, 2.16-3.76). CONCLUSIONS Results suggest a spectrum of risk from stroke symptoms to TIA, DS, and RS, and imply a need for establishing these categories in health screenings to manage risk for future stroke, reinforcing the clinical importance of stroke history including the presence of stroke symptoms.
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Affiliation(s)
- Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL 35294-0022, USA.
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Paul NLM, Simoni M, Chandratheva A, Rothwell PM. Population-based study of capsular warning syndrome and prognosis after early recurrent TIA. Neurology 2012; 79:1356-62. [PMID: 22972645 PMCID: PMC3448742 DOI: 10.1212/wnl.0b013e31826c1af8] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 05/08/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Many guidelines recommend emergency assessment for patients with ≥2 TIAs within 7 days, perhaps in recognition of the capsular warning syndrome. However, it is unclear whether all patients with multiple TIAs are at high early risk of stroke and whether treatable underlying pathologies are more prevalent in this group. METHODS We studied clinical characteristics, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and risk of stroke in 1,000 consecutive patients with incident and recurrent TIAs in a prospective, population-based study (Oxford Vascular Study). RESULTS Of 1,000 patients with TIAs, 170 had a further TIA within 7 days (105 within 24 hours). Multiple TIAs were not associated with carotid stenosis or atrial fibrillation, and much of the 10.6 (95% confidence interval [CI] 6.5-15.9) risk of stroke during the 7 days after the first TIA was due to patients with small-vessel disease (SVD) etiology (10 of 24 vs 8 of 146, odds ratio [OR] = 12.3, 95% CI 3.7-41.9, p < 0.0001), particularly those with motor weakness (i.e., capsular warning syndrome) compared with hemisensory events (9 of 15 [60%], 95% CI 35.3-84.7 vs 1 of 9 [11.1%], 95% CI 0-31.7, p = 0.03). The 7-day risk of stroke after a recurrent TIA was similar to the risk after a single TIA in patients with non-SVD TIA (8 of 146 [5.5%] vs 76 of 830 [9.2%], OR = 0.58, 95% CI 0.25-1.3, p = 0.20). Of the 9 patients with stroke after a capsular warning syndrome, all had the recurrent TIA within 24 hours after the first TIA, and the subsequent stroke occurred within 72 hours of the second TIA in 8. The ABCD2 scores of all preceding TIAs were ≥4 in all 9 patients with capsular warning syndrome before stroke. CONCLUSIONS Capsular warning syndrome is rare (1.5% of TIA presentations) but has a poor prognosis (7-day stroke risk of 60%). Otherwise, recurrent TIA within 7 days is not associated with a greater stroke risk than that after a single TIA.
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Affiliation(s)
- Nicola L M Paul
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
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Cardioembolic stroke is frequent in late recurrence after transient ischemic attack. J Stroke Cerebrovasc Dis 2012; 22:822-7. [PMID: 22795086 DOI: 10.1016/j.jstrokecerebrovasdis.2012.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 05/18/2012] [Accepted: 05/25/2012] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Transient ischemic attack (TIA) is often followed by a stroke episode. Differences between early and late recurrent stroke, however, have not been elucidated. METHODS We enrolled 133 consecutive patients with acute ischemic stroke who presented to our hospital and had previously been diagnosed with TIA. They were divided into 5 groups according to the interval between TIA and subsequent stroke: <48 hours (group 1); 48 hours to 1 week (group 2); 1 week to 1 month (group 3); 1 month to 3 months (group 4); and >3 months (group 5). Patients who underwent recurrent stroke within and after 1 week subsequent to TIA (the early and late recurrence groups, respectively) were compared with regard to clinical findings. RESULTS Of the 133 patients, 46 (34.6%) were in group 1, 29 (21.8%) in group 2, 23 (17.3%) in group 3, 18 (13.5%) in group 4, and 17 (12.8%) in group 5. Most of the noncardioembolic strokes were observed shortly after TIA, while the percentage of cardioembolic stroke remained high even after long post-TIA periods. The prevalence of atrial fibrillation (AF) was higher in the late recurrence group than in the early recurrence group (41.4% v 24.0%, P = .033). Among 42 patients with AF, 12 (28.6%) were newly diagnosed at the time of stroke. CONCLUSIONS The frequency of cardioembolic stroke did not decline as time after TIA passed. More than one quarter of AF patients had been asymptomatic before stroke, suggesting the need for repeated examinations to detect AF in patients with TIA of unknown etiology.
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Panagos PD. Transient ischemic attack (TIA): the initial diagnostic and therapeutic dilemma. Am J Emerg Med 2012; 30:794-9. [DOI: 10.1016/j.ajem.2011.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 03/01/2011] [Indexed: 02/01/2023] Open
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Arhami Dolatabadi A, Meisami A, Hatamabadi H, Mansori B, Shahrami A, Amini A, Jamali K. Improving the prediction of stroke or death after transient ischemic attack (TIA) by adding diffusion-weighted imaging lesions and TIA etiology to the ABCD2 score. J Stroke Cerebrovasc Dis 2012; 22:e25-30. [PMID: 22609319 DOI: 10.1016/j.jstrokecerebrovasdis.2012.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Revised: 03/14/2012] [Accepted: 03/21/2012] [Indexed: 01/12/2023] Open
Abstract
The present study investigated the addition of transient ischemic attack (TIA) etiology and diffusion-weighted imaging (DWI) to the ABCD2 score, creating the ABCDE+ score, to improve the predictive ability of stroke risk or death at 6 months after TIA. We performed a cohort study of 150 consecutive patients with TIA. All patients underwent DWI and all had an etiologic workup and were followed up for 6 months. The area under the receiver operating characteristic curve (AUC) was used to compare the scores' ability to predict the outcome of stroke or death. Multivariate Cox regression analysis was performed to evaluate the association between the measured variables and subsequent stroke or death. Thirty patients (20%) experienced future stroke, and 12 patients (8%) died within the 6-month follow-up. A comparison of AUCs demonstrated the superiority of the ABCDE+ score over the ABCD2 score for predicting stroke (0.64 vs 0.60) and for predicting death (0.62 vs 0.56). ABCD2 score >4, ABCDE+ score >6, large-artery disease, and lesions detected on DWI were found to be independent predictors of future stroke, and ABCDE+ score >6, age, and heart disease were independent predictors of death. We conclude that incorporating DWI positivity and etiology of TIA into the ABCD2 score can improve the ability to predict stroke and death within 6 months after TIA.
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Affiliation(s)
- Ali Arhami Dolatabadi
- Department of Emergency Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Lovrencic-Huzjan A, Rundek T, Katsnelson M. Recommendations for management of patients with carotid stenosis. Stroke Res Treat 2012; 2012:175869. [PMID: 22645702 PMCID: PMC3356946 DOI: 10.1155/2012/175869] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 01/05/2012] [Accepted: 01/24/2012] [Indexed: 02/03/2023] Open
Abstract
Stroke is a one of the leading causes of morbidity and mortality in the world. Carotid atherosclerosis is recognized as an important factor in stroke pathophysiology and represents a key target in stroke prevention; multiple treatment modalities have been developed to battle this disease. Multiple randomized trials have shown the efficacy of carotid endarterectomy in secondary stroke prevention. Carotid stenting, a newer treatment option, presents a less invasive alternative to the surgical intervention on carotid arteries. Advances in medical therapy have also enabled further risk reduction in the overall incidence of stroke. Despite numerous trials and decades of clinical research, the optimal management of symptomatic and asymptomatic carotid disease remains controversial. We will attempt to highlight some of the pivotal trials already completed, discuss the current controversies and complexities in the treatment decision-making, and postulate on what likely lies ahead. This paper will highlight the complexities of decision-making optimal treatment recommendations for patients with symptomatic and asymptomatic carotid stenosis.
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Affiliation(s)
- Arijana Lovrencic-Huzjan
- University Department of Neurology, University Hospital Center “Sisters of Mercy,” 10000 Zagreb, Croatia
| | - Tatjana Rundek
- Clinical Translational Research Division, Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Michael Katsnelson
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
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Perasso L, Spallarossa P, Gandolfo C, Ruggeri P, Balestrino M. Therapeutic Use of Creatine in Brain or Heart Ischemia: Available Data and Future Perspectives. Med Res Rev 2011; 33:336-63. [DOI: 10.1002/med.20255] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Luisa Perasso
- Department of Neuroscience, Opthalmology and Genetics; University of Genova; Genova Italy
- Department of Experimental Medicine, Section of Human Physiology; University of Genova; Genova Italy
| | - Paolo Spallarossa
- Department of Internal Medicine and Cardionephrology; University of Genova; Genova Italy
| | - Carlo Gandolfo
- Department of Neuroscience, Opthalmology and Genetics; University of Genova; Genova Italy
| | - Piero Ruggeri
- Department of Experimental Medicine, Section of Human Physiology; University of Genova; Genova Italy
| | - Maurizio Balestrino
- Department of Neuroscience, Opthalmology and Genetics; University of Genova; Genova Italy
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Park TS, Choi BJ, Lee TH, Song JS, Lee DY, Sung SM. Urgent recanalization with stenting for severe intracranial atherosclerosis after transient ischemic attack or minor stroke. J Korean Neurosurg Soc 2011; 50:322-6. [PMID: 22200014 DOI: 10.3340/jkns.2011.50.4.322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 08/19/2011] [Accepted: 10/17/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Stenting of symptomatic intracranial stenosis has recently become an alternative treatment modality. However, urgent intracranial stenting in patients with intracranial stenosis following a transient ischemic attack (TIA) or minor stroke is open to dispute. We sought to assess the feasibility, safety, and effectiveness of urgent intracranial stenting for severe stenosis (>70%) in TIA or minor stroke patients. METHODS Between June 2009 and October 2010, stent-assisted angioplasty by using a balloon-expandable coronary stent for intracranial severe stenosis (>70%) was performed in 7 patients after TIA and 5 patients after minor stroke (14 stenotic lesions). Technical success rates, complications, angiographic findings, and clinical outcomes were retrospectively analyzed. RESULTS Stenting was successful in all 12 patients. The mean time from symptom onset to stenting was 2.1 days (1-8 days). Post-procedural angiography showed restoration to a normal luminal diameter in all patients. In-stent thrombosis occurred in one patient (n=1, 8.3%), and was lysed with abciximab. No device-related complications, such as perforations or dissections at the target arteries or intracranial hemorrhaging, occurred in any patient. The mortality rate was 0%. No patient had an ischemic event over the mean follow-up period of 12.5 months (range, 7-21 months), and follow-up angiography (n=7) revealed no significant in-stent restenosis (>50%). CONCLUSION Urgent recanalization with stenting is feasible, safe, and effective in patients with TIA or acute minor stroke with intracranial stenosis of ≥70%.
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Affiliation(s)
- Tae Sik Park
- Department of Neurosurgery, Wallace Memorial Baptist Hospital, Busan, Korea
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Hoshino T, Mizuno S, Shimizu S, Uchiyama S. Clinical features and functional outcome of stroke after transient ischemic attack. J Stroke Cerebrovasc Dis 2011; 22:260-6. [PMID: 22005036 DOI: 10.1016/j.jstrokecerebrovasdis.2011.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 08/21/2011] [Accepted: 08/28/2011] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Transient ischemic attacks (TIAs) greatly increase the risk of stroke, but few reports have examined subsequent stroke in patients with history of TIA. METHODS This retrospective, hospital-based study included 506 consecutive patients with acute ischemic stroke who were admitted to our hospital. The clinical features and prognosis were compared between patients with and without TIA. Multiple logistic regression analysis was also performed to identify predictors for poor outcome. RESULTS Of 506 patients, 114 (22.5%) had a history of TIA. Compared to patients without previous TIAs (non-TIA group), patients with previous TIAs (TIA group) were significantly more likely to have hypertension (76.3% vs 64.3%; P = .016), dyslipidemia (57.0% vs 41.1%; P = .003), chronic kidney disease (28.1% v 15.1%; P = .001), intracranial major artery stenosis (51.8% vs 36.2%; P = .018), and large artery atherothrombosis (43.9% vs 28.3%; P = .002). There was no difference in the previous use of antithrombotic medications between the groups (36.0% vs 35.2%; P = .881). Although stroke severity on admission was similar, poor functional outcome (modified Rankin Scale score ≥4) was significantly more frequent in the TIA group, and history of TIA was an independent determinant of unfavorable outcome on multiple logistic regression analysis (odds ratio 1.46; 95% confidence interval 1.02-2.10; P = .041). CONCLUSIONS Atherothrombotic stroke with concomitant vascular risk factors were more frequent in the stroke patients with than without previous TIA. Antithrombotic therapy was conducted only in one-third of the patients even after TIA. The stroke patients with history of TIA were at great risk of disabling stroke.
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Affiliation(s)
- Takao Hoshino
- Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan.
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Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive Summary. Stroke 2011; 42:e420-63. [DOI: 10.1161/str.0b013e3182112d08] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
| | - Thomas G. Brott
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Jonathan L. Halperin
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Suhny Abbara
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - J. Michael Bacharach
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - John D. Barr
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | | | - Christopher U. Cates
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Mark A. Creager
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Susan B. Fowler
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Gary Friday
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | | | - E. Bruce McIff
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | | | - Peter D. Panagos
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Thomas S. Riles
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Robert H. Rosenwasser
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Allen J. Taylor
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
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45
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Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive Summary. Circulation 2011; 124:489-532. [DOI: 10.1161/cir.0b013e31820d8d78] [Citation(s) in RCA: 406] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas G. Brott
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Jonathan L. Halperin
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Suhny Abbara
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - J. Michael Bacharach
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - John D. Barr
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | | | - Christopher U. Cates
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Mark A. Creager
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Susan B. Fowler
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Gary Friday
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | | | - E. Bruce McIff
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | | | - Peter D. Panagos
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Thomas S. Riles
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Robert H. Rosenwasser
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Allen J. Taylor
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
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46
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Asdaghi N, Hameed B, Saini M, Jeerakathil T, Emery D, Butcher K. Acute perfusion and diffusion abnormalities predict early new MRI lesions 1 week after minor stroke and transient ischemic attack. Stroke 2011; 42:2191-5. [PMID: 21737809 DOI: 10.1161/strokeaha.110.611376] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Transient ischemic attack and minor stroke are associated with high ischemic recurrence in the first week. We prospectively studied the correlation between baseline diffusion/perfusion deficits and development of new ischemic lesions. METHODS Patients with transient ischemic attack and those with minor stroke (n=50) underwent MRI at admission. Acute perfusion-weighted imaging deficit (Tmax+2-second delay) and diffusion-weighted imaging (DWI) lesion volumes were measured planimetrically. Follow-up scans were examined for new DWI/fluid-attenuated inversion recovery lesions at Days 7 and 30. RESULTS Twenty-eight patients (56%) had acute DWI lesions. New DWI lesions developed in 9 of 50 patients (18%) at 1 week and 11 of 50 (cumulative 22%) at 4 weeks. Patients with new infarcts were more likely to have baseline DWI lesions (χ²=8.264, P=0.003). Baseline DWI lesion volume was significantly larger in those who developed new lesions at Day 7 (median, 13.2 mL; interquartile range, 12 versus median 0.1 mL; interquartile range, 2 mL; P<0.001) and Day 30 (11.1 mL; interquartile range, 13 mL versus 0.1 mL; interquartile range, 13 mL; P<0.001). Thirty-eight patients had baseline perfusion-weighted imaging. Patients with recurrent lesions were more likely to have baseline perfusion deficits (χ²=19.5, P<0.0001). All new lesions developed within the baseline hypoperfused regions. Baseline DWI lesion volume predicted new lesion development at day 7 (OR, 1.17 per mL; CI, 1.05 to 1.30; P=0.005) and Day 30 (OR, 1.39 per mL; CI, 1.03 to 1.26; P=0.009) by regression analysis. CONCLUSIONS Early recurrence of stroke is much more likely in patients with larger baseline DWI and perfusion-weighted imaging lesions. MRI lesion "recurrence" appears to be related to completion of the natural history of the original cerebrovascular syndrome rather than de novo events in most patients.
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Affiliation(s)
- Negar Asdaghi
- Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
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47
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Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/ SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive Summary. Vasc Med 2011; 16:35-77. [DOI: 10.1177/1358863x11399328] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Bonifati DM, Lorenzi A, Ermani M, Refatti F, Gremes E, Boninsegna C, Filipponi S, Orrico D. Carotid stenosis as predictor of stroke after transient ischemic attacks. J Neurol Sci 2011; 303:85-9. [DOI: 10.1016/j.jns.2011.01.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 12/06/2010] [Accepted: 01/07/2011] [Indexed: 11/30/2022]
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49
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Meyers JL, Davis KL, Yu YF. Stroke and Transient Ischemic Attack in the Long-Term Care Setting: Patient Characteristics, Medication Treatment, and Length of Stay. ACTA ACUST UNITED AC 2011; 26:170-81. [DOI: 10.4140/tcp.n.2011.170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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50
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Chandratheva A, Geraghty OC, Rothwell PM. Poor Performance of Current Prognostic Scores for Early Risk of Recurrence After Minor Stroke. Stroke 2011; 42:632-7. [PMID: 21273571 DOI: 10.1161/strokeaha.110.593301] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The ABCD
2
score predicts the early risk of stroke after transient ischemic attack. The early risk of recurrence after minor stroke is as high but the only validated prognostic scores for use in minor stroke predict long-term risk of recurrence: the Essen Stroke Risk Score and the Stroke Prognosis Instrument II.
Methods—
We determined the prognostic value of the ABCD
2
score, Essen Stroke Risk Score, and Stroke Prognosis Instrument II in a prospective population-based study in Oxfordshire, UK, of all incident and recurrent stroke (Oxford Vascular Study). Minor stroke was defined as an National Institutes of Health Stroke Scale score ≤5 at the time of first assessment. The 90-day risks of recurrent stroke were determined in relation to each score. Areas under the receiver operator curves indicated predictive value.
Results—
Of 1247 first events in the study period, 488 were transient ischemic attacks, 520 were minor strokes, and 239 were major strokes. The ABCD
2
score was modestly predictive (area under the receiver operator curve, 0.64; 0.53 to 0.74;
P
=0.03) of recurrence at 7 days after minor stroke and at 90 days (0.62; 0.54 to 0.70;
P
=0.004). Neither Essen Stroke Risk Score (0.50; 0.42 to 0.59;
P
=0.95) nor Stroke Prognosis Instrument II (0.48; 0.39 to 0.60;
P
=0.92) were predictive of 7-day or 90-day risk of recurrent stroke. Of the traditional vascular risk factors, etiologic classification (Trial of ORG 10172 in Acute Stroke Treatment) and variables in the ABCD
2
score, only blood pressure >140/90 mm Hg (hazard ratio, 2.75; 1.18 to 6.38;
P
=0.02) and large artery disease (hazard ratio, 2.21; 1.00 to 4.88;
P
=0.05) were predictive of 90-day risk.
Conclusions—
The predictive power of the ABCD
2
score is modest in patients with minor stroke, and neither the Essen Stroke Risk Score nor the Stroke Prognosis Instrument II predicts early recurrence. More reliable early risk prediction after minor stroke is required.
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Affiliation(s)
- Arvind Chandratheva
- From the Department of Clinical Neurology, University of Oxford, on behalf of the Oxford Vascular Study, Stroke Prevention Research Unit, Oxford University Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
| | - Olivia C. Geraghty
- From the Department of Clinical Neurology, University of Oxford, on behalf of the Oxford Vascular Study, Stroke Prevention Research Unit, Oxford University Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
| | - Peter M. Rothwell
- From the Department of Clinical Neurology, University of Oxford, on behalf of the Oxford Vascular Study, Stroke Prevention Research Unit, Oxford University Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
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