Outcomes of Mild Stroke and High-Risk Transient Ischemic Attack in Current Clinical Practice

Abstract

Early assessment and management of patients with mild stroke and transient ischemic attack (TIA) by specialists were recommended. Objectives: To evaluate the outcomes of these patients, and identify the predictive factors of clinical progression, unfavorable outcomes and recurrent stroke. Materials and Methods: Patients with mild ischemic stroke (NIHSS≤5) and high-risk TIA were studied. All patients were managed by stroke specialists within 24 hours of stroke onset. The outcomes of the patients at 3 months and final follow-up were studied. Predictive factors of clinical progression, unfavorable outcomes, and recurrent stroke were analyzed. Results: 254 patients were studied. Thirty-eight patients (15%) had clinical progression during admission. Large artery atherosclerosis (OR 2.49, 95%CI 1.06-5.81), cardioembolism (OR 3.34, 95%CI 1.26-8.87), and brainstem stroke (OR 2.78, 95%CI 1.28-6.01) were associated with clinical progression. At the final follow-up, median 22 months, 81 patients (32%) had unfavorable outcomes. Previous disability (OR 1.81, 95%CI 3.31-100), moderate to severe white matter lesions (OR 2.90, 95%CI 1.44-5.84), clinical progression (OR 12.5, 95%CI 5.08-31.25), and recurrent stroke (OR 8.47, 95%CI 3.21-22.72) were related to unfavorable outcomes. Eleven patients (4%) had recurrent stroke within 3 months and 31 patients (12%) at the final follow-up. Older age (OR 6.68, 95%CI 2.35-19.02), diabetes mellitus (OR 2.59, 95%CI 1.07-6.27) and smoking (OR 4.26, 95%CI 1.52-11.95) were related to recurrent stroke. Conclusion: Implementation of the up-to-date standard care in clinical practice might bring good clinical outcomes to the patients with mild stroke and high-risk TIA.

Differential distribution of plasma apoA-I and apoB levels and clinical significance of apoB/apoA-I ratio in ischemic stroke subtypes

“…While all three types of atherosclerotic lesions can result in IS, ICAS and ECAS are typically considered more severe due to their potential for large infarcts and hemispheric involvement. SAO, although associated with a higher risk of recurrent strokes, often presents with smaller lesions and milder clinical manifestations ( 32–34 ).…”