Carotid stenosis as predictor of stroke after transient ischemic attacks

Bonifati, Domenico Marco; Lorenzi, Alessandra; Ermani, Mario; Refatti, Franca; Gremes, Elisabetta; Boninsegna, Claudio; Filipponi, Stefania; Orrico, Daniele

doi:10.1016/j.jns.2011.01.005

Cited by 30 publications

(27 citation statements)

References 29 publications

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“…Eleven were population-based studies including cohorts from the UK (Oxford), Ireland (Dublin), USA (Texas and Minnesota), Canada (Alberta) and northern Portugal. 9 23,127,129,131,135,136,143,149,153,159 and by both in four; 62,158,162,163 in three studies 120,138,155 this information was not reported.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 94%

“…telephone interviews, medical records, letters) in 11 studies, 65,131,[146][147][148]153,154,158,160,162,163 and was not reported in two studies.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…178 To reduce the impact of any between-study heterogeneity, we considered separately the 10 studies that provided data on stroke risk at both 7 and 90 days. 62,137,139,143,[149][150][151][152]158,163 The study by Asimos and colleagues was published in two reports. 136,143 Even although the same cohort of patients was studied in both publications, data on risk of stroke at 7 days were reported in the 2010 publication, whereas data on risk of stroke at 90 days were reported in the 2009 publication.…”

Section: Main Findingsmentioning

confidence: 99%

“…Four studies assessed population-based cohorts, 132,140,144,151 three studies hospital-based cohorts, 142,155,160 nine studies patients from EDs, 87,134,135,143,149,153,158,162,163 and 10 studies patients from specialist stroke or neurology units. 62,[137][138][139]145,146,150,152,164,177 Full-text papers assessed (n = 61)…”

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confidence: 99%

“…Similarly, information on how many TIA patients received secondary prevention drugs was rarely reported in the included studies. Only five studies stated that approximately 45-50% of TIA patients were administered antithrombotic therapy, 143,152,153,158,162 and another study that 15% of patients received aspirin.…”

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confidence: 99%

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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

Wardlaw

Brazzelli

Miranda

et al. 2014

Health Technol Assess

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BackgroundPatients 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.ObjectivesIs 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 sourcesPublished literature; stroke registries, audit and randomised clinical trials; national databases; survey of UK clinical and imaging services for stroke; expert opinion.Review methodsSystematic 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.ResultsThe 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.LimitationsData 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.ConclusionsMagnetic 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.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Characteristics Of Included Studiesmentioning

confidence: 94%

“…telephone interviews, medical records, letters) in 11 studies, 65,131,[146][147][148]153,154,158,160,162,163 and was not reported in two studies.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Main Findingsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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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

Wardlaw

Brazzelli

Miranda

et al. 2014

Health Technol Assess

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Risk of Subsequent Stroke Among Patients Receiving Outpatient vs Inpatient Care for Transient Ischemic Attack

et al. 2022

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A 5-Decade Analysis of Incidence Trends of Ischemic Stroke After Transient Ischemic Attack

et al. 2021

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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 SYNTHESISThe 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 τ 2 statistic and Egger bias test. Data were pooled using double arcsine transformations, DerSimonian-Laird estimator, and random-effects models. MAIN OUTCOMES AND MEASURESThe 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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Carotid stenosis as predictor of stroke after transient ischemic attacks

Cited by 30 publications

References 29 publications

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

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

Risk of Subsequent Stroke Among Patients Receiving Outpatient vs Inpatient Care for Transient Ischemic Attack

A 5-Decade Analysis of Incidence Trends of Ischemic Stroke After Transient Ischemic Attack

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