Recurrent Events in Transient Ischemic Attack and Minor Stroke

Coutts, Shelagh B.; Hill, Michael D.; Campos, Cynthia Resende; Choi, Young Bin; Subramaniam, Suresh; Kosior, Jayme C.; Demchuk, Andrew M.

doi:10.1161/strokeaha.107.513234

Cited by 87 publications

(92 citation statements)

References 33 publications

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“…Among those with a neurologic deficit lasting longer than 24 hours, the risk of subsequent stroke varies, with particularly high risk, comparable to that of time-defined TIA, observed in those with nondisabling symptoms and lower risk in those with major or disabling deficits. 39,40 It has been proposed that a new syndrome-transient symptoms with infarction-should be recognized because of the differing prognosis between those with transient symptoms with and without infarction and those with a permanent deficit. 15 In conclusion, we have found that subcategorization of patients with TIA as defined by time-based criteria into tissue-positive and tissue-negative groups yields helpful prognostic information, especially when brain infarction is found on DWI.…”

Section: Figure Pooled Analysis Of Association Between Abcd2 Score Anmentioning

confidence: 99%

Early stroke risk and ABCD2 score performance in tissue- vs time-defined TIA

Giles¹,

Albers²,

Amarenco³

et al. 2011

Neurology

147

107

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Objectives: Stroke risk immediately after TIA defined by time-based criteria is high, and prognostic scores (ABCD2 and ABCD3-I) have been developed to assist management. The American Stroke Association has proposed changing the criteria for the distinction between TIA and stroke from time-based to tissue-based. Research using these definitions is lacking. In a multicenter observational cohort study, we have investigated prognosis and performance of the ABCD2 score in TIA, subcategorized as tissue-positive or tissue-negative on diffusion-weighted imaging (DWI) or CT imaging according to the newly proposed criteria.Methods: Twelve centers provided data on ABCD2 scores, DWI or CT brain imaging, and follow-up in cohorts of patients with TIA diagnosed by time-based criteria. Stroke rates at 7 and 90 days were studied in relation to tissue-positive or tissue-negative subcategorization, according to the presence or absence of brain infarction. The predictive power of the ABCD2 score was determined using area under receiver operator characteristic curve (AUC) analyses.Results: A total of 4,574 patients were included. Among DWI patients (n ϭ 3,206), recurrent stroke rates at 7 days were 7.1% (95% confidence interval 5.5-9.1) after tissue-positive and 0.4% (0.2-0.7) after tissue-negative events (p diff Ͻ 0.0001). Corresponding rates in CT-imaged patients were 12.8% (9.3-17.4) and 3.0% (2.0-4.

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Section: Figure Pooled Analysis Of Association Between Abcd2 Score Anmentioning

confidence: 99%

Early stroke risk and ABCD2 score performance in tissue- vs time-defined TIA

Giles¹,

Albers²,

Amarenco³

et al. 2011

Neurology

147

107

View full text Add to dashboard Cite

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“…Recent magnetic resonance imagaing studies suggest that early strokes are in fact a progression of the initial event, and it may be the case that a subset of our patients with early stroke represented either fluctuating lacunar syndromes, or infarction following partial large vessel occlusions. 16 Additional studies with baseline computed tommography-angiography and/or magnetic resonance imaging are required to explore this.…”

Section: Research Implicationsmentioning

confidence: 99%

Stratified, Urgent Care for Transient Ischemic Attack Results in Low Stroke Rates

Wasserman

Perry

Dowlatshahi

et al. 2010

Stroke

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Background and Purpose-Transient ischemic attack (TIA) is a marker for early risk of stroke. No previous studies have assessed the use of urgent stroke prevention clinics for emergency department (ED) patients with TIA. We hypothesized that an ABCD2-based ED triaging tool for TIA with outpatient management would be associated with lower 90-day stroke rate than that predicted by ABCD2. Methods-A cohort of prospectively identified patients presenting with symptoms suggestive of TIA seen in 2 tertiary-careEDs. These patients were divided into 3 strata based on their ACBD2 score, and triage targets were set for each stratum. All patients received the same standard of care in the Stroke Clinic regardless of their risk score. Primary outcome was stroke by 90 days of index TIA. Secondary outcomes were subsequent TIA, myocardial infarction, or death. Results-One-thousand ninety-three patients met the inclusion criteria; 982 patients completed 90-day follow-up and comprised the final cohort. After stratification, 32%, 49%, and 19% of patients were categorized as low-, moderate-, or high-risk, respectively. The overall 90-day risk of stroke in all patients was 3.2%, compared with the ABCD2-predicted risk of 9.2%. Only 1.6% of patients with TIA/minor stroke were admitted from the ED. The risk of subsequent TIA, myocardial infarction, or death by 90 days was 5.5%, 0.1%, and 1.7%, respectively. Conclusion-Outpatient care in a rapid-access stroke prevention clinic using the ABCD2 score for triage resulted in a low 90-day stroke rate for patients in the ED with TIA. Benefit occurred without requiring admission for most patients.

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“…Additionally, Arnold et al have shown that a normal angiogram portends a good prognosis [10]. Cerebral transient ischemic attacks in patients with large vessel occlusion have been found to have a 40% higher rate of second stroke than those with a normal MRA [11].…”

Section: Discussionmentioning

confidence: 99%