Thrombolytic therapy in ischemic stroke patients with a preceding transient ischemic attack in telestroke and non‐telestroke settings

2020 ◽  
Vol 8 (5) ◽  
pp. 298-308
Author(s):  
Nicolas Poupore ◽  
Dan Strat ◽  
Tristan Mackey ◽  
Katherine Brown ◽  
Ashley Snell ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Transient Ischemic Attack ◽  
Stroke Patients ◽  
Ischemic Attack

Safety of Thrombolytic Therapy for Acute Ischemic Stroke after Recent Transient Ischemic Attack

2012 ◽  
Vol 21 (7) ◽  
pp. 551-554 ◽  
Author(s):  
James S. McKinney ◽  
Jaime Masjuan ◽  
Francisco Purroy ◽  
David Calvet ◽  
Hakan Ay ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Acute Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Ischemic Attack

scholarly journals Coronary Artery Disease in Patients Presenting With Acute Ischemic Stroke or Transient Ischemic Attack and Elevated Troponin Levels

2022 ◽  
Vol 12 ◽  
Author(s):  
Mathieu Kruska ◽  
Anna Kolb ◽  
Christian Fastner ◽  
Iris Mildenberger ◽  
Svetlana Hetjens ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Ischemic Stroke ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Transient Ischemic Attack ◽  
Large Artery ◽  
Elevated Troponin ◽  
Stroke Patients ◽  
Artery Disease ◽  
Ischemic Attack

Background: There is little information concerning the invasive coronary angiography (ICA) findings of patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) with elevated troponin levels and suspected myocardial infarction (MI). This study analyzed patient characteristics associated with ICA outcomes.Methods: A total of 8,322 patients with AIS or TIA, treated between March 2010 and May 2020, were retrospectively screened for elevated serum troponin I at hospital admission. Patients in whom ICA was performed, due to suspected type 1 MI based on symptoms, echocardiography, and ECG, were categorized according to ICA results (non-obstructive coronary artery disease (CAD): ≥1 stenosis ≥50% but no stenosis ≥80%; obstructive CAD: any stenosis ≥80% or hemodynamically relevant stenosis assessed by FFR/iwFR).Results: Elevated troponin levels were detected in 2,205 (22.5%) patients, of whom 123 (5.6%) underwent ICA (mean age 71 ± 12 years; 67% male). CAD was present in 98 (80%) patients, of whom 51 (41%) were diagnosed with obstructive CAD. Thus, ICA findings of obstructive CAD accounted for 2.3% of patients with troponin elevation and 0.6% of all stroke patients. The clinical hallmarks of myocardial ischemia, including angina pectoris (31 vs. 15%, p < 0.05) and regional wall motion abnormalities (49 vs. 32%, p = 0.07), and increased cardiovascular risk indicated obstructive CAD. While there was no association between lesion site or stroke severity and ICA findings, causal large-artery atherosclerosis was significantly more common in patients with obstructive coronary disease (p < 0.05).Conclusion: The rate of obstructive CAD in patients with stroke or TIA and elevated troponin levels with suspected concomitant type I MI is low. The cumulation of several cardiovascular risk factors and clinical signs of MI were predictive. AIS patients with large-artery atherosclerosis and elevated troponin may represent an especially vulnerable subgroup of stroke patients with risk for obstructive CAD.

scholarly journals Comparison of Carotid Atherosclerotic Plaque Characteristics between Symptomatic Patients with Transient Ischemic Attack and Stroke using High-Resolution Magnetic Resonance Imaging

2021 ◽  
Author(s):  
Mingming Lu ◽  
Lichen Zhang ◽  
Fei Yuan ◽  
Peng Peng ◽  
Hongtao Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Transient Ischemic Attack ◽  
Carotid Arteries ◽  
Plaque Burden ◽  
Plaque Morphology ◽  
Stroke Patients ◽  
Carotid Plaques ◽  
Ischemic Attack ◽  
Ischemic Events

Abstract Background:This study aimed to compare the characteristics of carotid plaques between patients with transient ischemic attack (TIA) and ischemic stroke using magnetic resonance (MR) imaging.Methods：Patients with a recent ischemic stroke or TIA who exhibited atherosclerotic plaques of carotid arteries in the symptomatic sides determined by MR vessel wall imaging were recruited. The plaque morphology and compositions including intraplaque hemorrhage (IPH), lipid-rich necrotic-core (LRNC) and calcification were compared between TIA and stroke patients. Logistic regression was performed to relate the plaque characteristics to the types of ischemic events.Results:A total of 270 patients with TIA or ischemic stroke were recruited. Stroke patients had significantly higher prevalence of diabetes (42.2% vs. 28.2%, p=0.021), greater mean wall area (35.1 ± 10.1 mm2 vs. 32.0 ± 7.7 mm2, p = 0.004), mean wall thickness (1.3 ± 0.2 mm vs. 1.2 ± 0.2 mm, p=0.001), maximum normalized wall index (NWI)(63.9% ± 6.0% vs. 62.2% ± 5.9%, p=0.023) and %volume of LRNC (9.7%± 8.2% vs. 7.4% ±7.9%, p=0.025) in carotid arteries compared to those with TIA. After adjusted for clinical factors, above characteristics of carotid arteries were significantly associated with the type of ischemic events. After further adjusted for maximum NWI, this association remained statistically significant (OR, 1.41; CI, 1.01-1.96; p=0.041).Conclusions:Ischemic stroke patients had larger plaque burden and greater proportion of LRNC in carotid plaques compared to those with TIA. This study suggests that ischemic stroke patients had more vulnerable plaques compared to those with TIA.

scholarly journals Acute stroke and TIA patients have specific polygraphic features of obstructive sleep apnea

2020 ◽  
Vol 24 (4) ◽  
pp. 1495-1505 ◽  
Author(s):  
Akseli Leino ◽  
Susanna Westeren-Punnonen ◽  
Juha Töyräs ◽  
Sami Myllymaa ◽  
Timo Leppänen ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Ischemic Stroke ◽  
Sleep Apnea ◽  
Transient Ischemic Attack ◽  
Sleep Disordered Breathing ◽  
Apnea Hypopnea Index ◽  
Stroke Patients ◽  
Respiratory Events ◽  
Obstructive Sleep ◽  
Ischemic Attack

Abstract Purpose Obstructive sleep apnea (OSA) is associated with increased risk for stroke, which is known to further impair respiratory functions. However, it is unknown whether the type and severity of respiratory events are linked to stroke or transient ischemic attack (TIA). Thus, we investigate whether the characteristics of individual respiratory events differ between patients experiencing TIA or acute ischemic stroke and matched patients with clinically suspected sleep-disordered breathing. Methods Polygraphic data of 77 in-patients with acute ischemic stroke (n = 49) or TIA (n = 28) were compared to age, gender, and BMI-matched patients with suspected sleep-disordered breathing and no cerebrovascular disease. Along with conventional diagnostic parameters (e.g., apnea-hypopnea index), durations and severities of individual apneas, hypopneas and desaturations were compared between the groups separately for ischemic stroke and TIA patients. Results Stroke and TIA patients had significantly shorter apneas and hypopneas (p < 0.001) compared to matched reference patients. Furthermore, stroke patients had more central apnea events (p = 0.007) and a trend for higher apnea/hypopnea number ratios (p = 0.091). The prevalence of OSA (apnea-hypopnea index ≥ 5) was 90% in acute stroke patients and 79% in transient ischemic attack patients. Conclusion Stroke patients had different characteristics of respiratory events, i.e., their polygraphic phenotype of OSA differs compared to matched reference patients. The observed differences in polygraphic features might indicate that stroke and TIA patients suffer from OSA phenotype recently associated with increased cardiovascular mortality. Therefore, optimal diagnostics and treatment require routine OSA screening in patients with acute cerebrovascular disease, even without previous suspicion of OSA.

scholarly journals Prevalence of Thrombophilia in Transient Ischemic Attack and Ischemic Stroke Patients

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 3-3
Author(s):  
Omar Raslan ◽  
Christopher Tran ◽  
Fatimah Al-Ani ◽  
Luciano Sposato ◽  
Alejandro Lazo-Langner
Keyword(s):  
Ischemic Stroke ◽  
High Risk ◽  
Transient Ischemic Attack ◽  
Patent Foramen Ovale ◽  
Research Funding ◽  
Transient Ischemic Attacks ◽  
Foramen Ovale ◽  
Stroke Patients ◽  
Thrombophilia Screening ◽  
Ischemic Attack

Introduction. Screening for inherited thrombophilia has been recommended in patients with cryptogenic ischemic strokes and anticoagulant therapy is frequently indicated based on these results. However, current evidence suggests that thrombophilia screening is over utilized in stroke patients and may provide more risks than benefits. Patients and Methods.We conducted a retrospective cohort study in patients with transient ischemic attack (TIA) or ischemic stroke who had a thrombophilia screen and determined the proportions of each thrombophilia trait, and the proportion of high risk thrombophilia in this population. Pre-specified subgroup analyses were conducted for patients with ischemic stroke and transient ischemic attacks, and for patients with patent foramen ovale. Results.We included 412 patients (152 male and 260 female). The prevalence of thrombophilia was 7.52% (95% CI 5.35-10.48). The proportion of major thrombophilia was 2.18 (95% CI=1.15 - 4.09). The proportion of thrombophilia traits in ischemic stroke patients was lower 4.92% (95% CI 2.61 - 9.08) than that in patients with transient ischemic attacks 9.57% (95% CI = 6.41 - 14.06); Only 2 individuals had both a positive thrombophilia screen and a patent foramen ovale. Discussion. In this study the prevalence of thrombophilia traits in patients with ischemic stroke or transient ischemic attack was low, including high risk thrombophilic traits. Further studies are needed to determine if thrombophilia screening exposes these patients to additional risks without any benefits. Disclosures Sposato: Western University:Other: Kathleen and Dr. Henry Barnett Chair in Stroke Research;Boehringer Ingelheim:Honoraria, Research Funding;Pfizer:Honoraria, Research Funding;Gore:Honoraria, Research Funding;Bayer:Honoraria, Research Funding.

Recommendations for lipid modification in patients with ischemic stroke or transient ischemic attack: A clinical guide by the Hellenic Stroke Organization and the Hellenic Atherosclerosis Society

2020 ◽  
pp. 174749302097197
Author(s):  
Dimitrios Sagris ◽  
George Ntaios ◽  
Georgios Georgiopoulos ◽  
Nikolaos Kakaletsis ◽  
Moses Elisaf ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Practice ◽  
Current Literature ◽  
Transient Ischemic Attack ◽  
Lipid Modification ◽  
Stroke Patients ◽  
Lipid Management ◽  
Consensus Recommendations ◽  
Ischemic Attack

This document presents the consensus recommendations of the Hellenic Stroke Organization and the Hellenic Atherosclerosis Society for lipid modification in patients with ischemic stroke or transient ischemic attack. This clinical guide summarizes the current literature on lipid management and can be of assistance to the physicians treating stroke patients in clinical practice.

Clinical Application of Intravenous Thrombolysis in Transient Ischemic Attack and Ischemic Stroke Guided by Multimodal MRI

2021 ◽  
Vol 11 (2) ◽  
pp. 584-589
Author(s):  
Aixia Song ◽  
Jing Chen ◽  
Yan Sun ◽  
Xiaoqin Wang ◽  
Jichao Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Antiplatelet Therapy ◽  
Clinical Application ◽  
Transient Ischemic Attack ◽  
Intravenous Thrombolysis ◽  
Group A ◽  
Multimodal Mri ◽  
Ischemic Attack ◽  
Group B

Objective: To investigate the therapeutic effect of intravenous thrombolysis on TIA (Transient Ischemic Attack) under the guidance of multimodal MRI (magnetic resonance imaging), and the clinical application of intravenous thrombolysis in patients with ischemic stroke. Methods: Patients with acute ischemic stroke who underwent intravenous thrombolysis in the Department of Neurology from December 2017 to December 2018 were selected. Through CT (computed tomography) screening, 146 patients that met the diagnostic criteria were eventually included. Patients were randomly divided into group A (72 patients) and group B (74 patients). Patients in group A received antiplatelet therapy within 24 h after intravenous thrombolytic therapy for 10 days. The platelet therapy was discontinued when symptomatic intracerebral hemorrhage (SICH) occurred or NIHSS score was ≥4. In group B, after intravenous thrombolysis and antiplatelet therapy, multimodal MRI was used to detect the presence of hemorrhage and other conditions to determine whether to continue the antiplatelet therapy. The NIHSS scores before and after thrombolysis and the 90-day mRS scores after thrombolysis were collected for statistical analysis. Results: The experimental results of each group of patients showed that there was a signif- icant difference in NIHSS scores at admission and 6 h after thrombolysis (P < 0.05). The 30-day mRS score, 90-day mRS score, and prognosis were statistically significant in both groups. The differences in NIHSS scores at 6 h, 24 h, 7 d, and 14 d after thrombolysis and at admission were 1, 1.6, 1.8, and 2.8, which were statistically significant. A comparison of the prognosis of the two groups of patients with hemorrhage 24 h after thrombolysis revealed that the hemorrhage of each patient was improved. Conclusion: In the treatment of ischemic stroke diseases, the utilization of multimodal MRI in clinical intravenous thrombolytic therapy was valuable, which was very sensitive to the detection and display of blood focus. Also, in the selection of treatment methods for clinical thrombolysis in stroke patients, the targeted treatment could be better individualized for each patient.

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