Early risk of recurrence by subtype of ischemic stroke in population-based incidence studies

Lovett, J K; Coull, Andrew; Rothwell, Peter M.

doi:10.1212/01.wnl.0000110311.09970.83

Cited by 685 publications

(457 citation statements)

References 21 publications

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“…Large artery atherosclerosis had the highest risk of 30‐day recurrence in our study, as previously reported by other studies (Lovett et al, 2004; Petty et al, 2000; Sacco, 1997). Considering that CEA is highly effective for reducing recurrent stroke in selected patients with stenosis of the internal carotid artery (Rothwell et al, 2003), knowing the risk of early recurrence is important for the stroke clinician in order to select and time patients for surgery.…”

Section: Discussionsupporting

confidence: 91%

“…There is scant information on stroke recurrence in Norway, but our rate is low compared to many large international incidence studies (Bravata, Ho, Meehan, Brass, & Concato, 2007; Lovett et al, 2004; Sacco et al, 1994; Smith, Frytak, Liou, & Finch, 2005). Most of these studies included patients dating several decades back.…”

Section: Discussionmentioning

confidence: 83%

“…SVO also is reported to have low recurrence rates (Jones et al, 2013; Lovett et al, 2004; Petty et al, 2000; Sacco, 1997). Although the exact pathology of stroke due to SVO is still under debate, the process leading to stroke is thought to be intrinsic to the small vessels (Wardlaw, 2005).…”

Section: Discussionmentioning

confidence: 99%

“…Recurrent stroke is associated with increased disability and mortality compared to the index stroke (Petty et al, 1998; Sacco, Wolf, Kannel, & McNamara, 1982). And even with appropriate prevention, the risk of recurrence after ischemic stroke (IS) and transient ischemic attack (TIA) is high, especially in the early phase after stroke (Lovett, Coull, & Rothwell, 2004; Sacco, Shi, Zamanillo, & Kargman, 1994). Paradoxically, many large studies on recurrent stroke incidence have excluded events occurring within the first month leaving a lack of data regarding early recurrence (Coull & Rothwell, 2004).…”

Section: Introductionmentioning

confidence: 99%

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Thirty‐day recurrence after ischemic stroke or TIA

et al. 2018

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BackgroundIncidence of recurrent stroke is highest within 30 days after the initial ischemic stroke (IS) or TIA, but knowledge about early recurrence is lacking. We aimed to identify etiological groups with highest risk of early recurrence and assess how the TOAST classification identified index stroke etiology.MethodsMedical records of 1874 IS and TIA patients in the Bergen NORSTROKE registry were retrospectively reviewed for identification of recurrent IS or TIA within 30 days after index IS or TIA. Stroke etiology was determined by review of electronical medical journals. Logistic regression was used to calculate odds ratios (OR) for 30‐day recurrence.ResultsThirty‐three patients (1.8%) were readmitted with recurrent IS or TIA within 30 days after index stroke. By using TOAST, 12 patients were initially classified with stroke of unknown etiology (SUE). Etiologies behind recurrent IS or TIA were after the recurrent episode identified as extracranial large artery atherosclerosis (LAA) in 14 patients (42.4%), intracranial arterial pathology in seven patients (21.2%), active malignancy in six patients (18.2%), and cardio embolism in four patients (12.1%). Small vessel occlusion and SUE were the causes in one patient each. Logistic regression showed that patients with stroke of other determined etiology (SOE) and LAA had increased risk of 30‐day recurrence (OR = 9.72, 95% CI 1.84–51.3, p < 0.01 and OR = 4.36, 95% CI 2.01–9.47, p < 0.01, respectively).ConclusionPatients with LAA and SOE had increased risk of recurrent IS or TIA within 30 days. TOAST was inadequate at identifying exact etiologies behind recurrent stroke at index event.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Thirty‐day recurrence after ischemic stroke or TIA

et al. 2018

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“…Recurrent risk is associated with the underlying stroke etiology [9][10][11]. The estimated risk of stroke recurrence is 10 to 20% within the first 3 months.…”

Section: Clinical Trials For Prevention Of Early Stroke Recurrencesmentioning

confidence: 99%

Antiplatelet Agents for Stroke Prevention

Yip

Benavente

2011

Neurotherapeutics

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Stroke is one of the leading causes of disability and death. Ischemic stroke is a syndrome with heterogeneous mechanisms and multiple etiologies, rather than a singularly defined disease. Approximately one third of ischemic strokes are preceded by another cerebrovascular ischemic event. Stroke survivors are at high risk of vascular events (i.e., cerebrovascular and cardiovascular events), particularly during the first several months after the ischemic event. The use of antiplatelet agents remains the fundamental component of secondary stroke prevention. Based on the available data, antiplatelet agents should be used for patients with noncardioembolic stroke. The use of combination therapy (aspirin plus clopidogrel) has not been proven to be effective or safe to use for prevention of early stroke recurrence or in long-term treatment. There is no convincing evidence that any of the available antiplatelet agents are superior for a given stroke subtype. Currently, the uses of aspirin, clopidogrel, or aspirin combined with extended release dipyridamole are all valid alternatives after an ischemic stroke or transient ischemic attack. However, to maximize the effects of these agents, the treatment should be initiated as early as possible and be continued on a lifelong basis.

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Early Recurrent Ischemic Lesions on Diffusion-Weighted Imaging in Symptomatic Intracranial Atherosclerosis

Kang

Kwon²,

Yoo³

et al. 2007

Arch Neurol

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Background:Prior observations have shown that early recurrent ischemic lesions (ERILs) on diffusionweighted imaging occur frequently within the first week after an index stroke.Objective: To investigate differential patterns of ERILs among stroke subtypes, particularly intracranial largeartery atherosclerosis (IC-LAA).Design: Retrospective study.Setting: Tertiary university hospital. Patients:We included 133 patients who experienced an acute ischemic stroke and who underwent initial diffusion-weighted imaging within 24 hours and subsequent diffusion-weighted imaging within 7 days after onset, and whose stroke subtype was IC-LAA, extracranial LAA (EC-LAA), or cardioembolism (CE).Main Outcome Measure: Early recurrent ischemic lesions were defined as new ischemic lesions on follow-up diffusion-weighted imaging, separate from the index stroke lesion.Results: Early recurrent ischemic lesions were observed in the following proportions: 50.9% (28/55) in the IC-LAA group, 47.4% (9/19) in the EC-LAA group, and 44.1% (26/59) in the CE group. Early recurrent ischemic lesions in the IC-LAA group had the following characteristics: (1) they occurred mostly (27 [96.4%] of 28) in the pial area of the same vascular territory as the index stroke; (2) they were more frequently observed in a higher grade of stenosis than in milder stenosis (PϽ.001), whereas ERILs in the EC-LAA group were not related to the degree of stenosis; (3) they were not associated with subsequent recanalization, whereas ERILs in the CE group were mostly associated with subsequent recanalization (PϽ.001); and (4) they were more closely associated with clinical recurrence than in the EC-LAA or CE group (P=.02). Conclusion:Early recurrent ischemic lesions in the IC-LAA group are relatively frequent and have different patterns than in the EC-LAA or CE group.

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Early risk of recurrence by subtype of ischemic stroke in population-based incidence studies

Abstract: The risk of early recurrent stroke is highest in patients with LAA. This supports the need for urgent carotid imaging and prompt endarterectomy.

Cited by 685 publications

References 21 publications

Thirty‐day recurrence after ischemic stroke or TIA

Thirty‐day recurrence after ischemic stroke or TIA

Antiplatelet Agents for Stroke Prevention

Early Recurrent Ischemic Lesions on Diffusion-Weighted Imaging in Symptomatic Intracranial Atherosclerosis

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