Cerebral Microbleeds Are Not Associated with Long-Term Cognitive Outcome in Patients with Transient Ischemic Attack or Minor Stroke

2014 ◽  
Vol 37 (3) ◽  
pp. 195-202 ◽  
Author(s):  
Manon Brundel ◽  
Vincent I.H. Kwa ◽  
Willem H. Bouvy ◽  
Ale Algra ◽  
L. Jaap Kappelle ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Cerebral Microbleeds ◽  
Cognitive Outcome ◽  
Minor Stroke ◽  
Ischemic Attack

scholarly journals Long-Term Impact of Urgent Secondary Prevention After Transient Ischemic Attack and Minor Stroke: Ten-Year Follow-Up of the EXPRESS Study

Stroke ◽  
2021 ◽  
Author(s):  
Ramon Luengo-Fernandez ◽  
Linxin Li ◽  
Louise Silver ◽  
Sergei Gutnikov ◽  
Nicola C. Beddows ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Hazard Ratio ◽  
Minor Stroke ◽  
Phase 2 ◽  
Short Term ◽  
Ischemic Attack

Background and Purpose: Urgent assessment aimed at reducing stroke risk after transient ischemic attack or minor stroke is cost-effective over the short-term. However, it is unclear if the short-term impact is lost on long-term follow-up, with recurrent events being delayed rather than prevented. By 10-year follow-up of the EXPRESS study (Early Use of Existing Preventive Strategies for Stroke), previously showing urgent assessment reduced 90-day stroke risk by 80%, we determined whether that early benefit was still evident long-term for stroke risk, disability, and costs. Methods: EXPRESS was a prospective population-based before (phase 1: April 2002–September 2004; n=310) versus after (phase 2: October 2004–March 2007; n=281) study of the effect of early assessment and treatment of transient ischemic attack/minor stroke on early recurrent stroke risk, with an external control. This report assesses the effect on 10-year recurrent stroke risk, functional outcomes, quality-of-life, and costs. Results: A reduction in stroke risk in phase 2 was still evident at 10 years (55/23.3% versus 82/31.6%; hazard ratio=0.68 [95% CI, 0.48–0.95]; P =0.024), as was the impact on risk of disabling or fatal stroke (17/7.7% versus 32/13.1%; hazard ratio=0.54 [0.30–0.97]; P =0.036). These effects were due to maintenance of the early reduction in stroke risk, with neither additional benefit nor rebound catch-up after 90 days (post-90 days hazard ratio=0.88 [0.65–1.44], P =0.88; and hazard ratio=0.83 [0.42–1.65], P =0.59, respectively). Disability-free life expectancy was 0.59 (0.03–1.15; P =0.043) years higher in patients in phase 2, as was quality-adjusted life expectancy (0.49 [0.03–0.95]; P =0.036). Overall, 10-year costs were nonsignificantly higher in patients attending the phase 2 clinic ($1022 [-3865–5907]; P =0.66). The additional cost per quality-adjusted life year gained in phase 2 versus phase 1 was $2103, well below current cost-effectiveness thresholds. Conclusions: Urgent assessment and treatment of patients with transient ischemic attack or minor stroke resulted in a long-term reduction in recurrent strokes and improved outcomes, with little atrophy of the early benefit over time, representing good value for money even with a 10-year time horizon. Our results suggest that other effective acute treatments in transient ischemic attack/minor stroke in the short-term will also have the potential to have long-term benefit.

Domain-Specific Cognitive Trajectories Among Patients with Minor Stroke or Transient Ischemic Attack in a 6-Year Prospective Asian Cohort: Serial Patterns and Indicators

2021 ◽  
pp. 1-12
Author(s):  
Xuhao Zhao ◽  
Eddie Jun Yi Chong ◽  
Wei Qi ◽  
Ting Pang ◽  
Xin Xu ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Verbal Memory ◽  
Visual Memory ◽  
Linear Models ◽  
Minor Stroke ◽  
Cognitive Changes ◽  
Domain Specific ◽  
Cognitive Improvement ◽  
Ischemic Attack

Background: Long-term post-stroke cognitive impairment (PSCI) has often been overlooked, especially among patients with minor stroke or transient ischemic attack (TIA). Objective: To assess 6-year domain-specific cognitive trajectories among survivors of minor stroke or TIA and to identify possible indicators associated with cognitive trajectories, as well as long-term and incident PSCI. Methods: Eligible participants completed cognitive and clinical assessments at baseline (2 weeks after stroke) and up to 5 follow-up visits in 6 years. Mixed linear models and generalized estimating equations were adopted to analyze longitudinal data and survival analysis to explore incident PSCI, controlling for demographic, clinical, and vascular indicators. Results: The prevalence of PSCI and mortality rate ranged from 34.6% to 53.7%, and 0 to 7.7% respectively, among 244 patients. Incidence of PSCI was 21.9%. While visual memory demonstrated a significant improvement (p <  0.05), other cognitive domains showed a fluctuating yet stable pattern across visits (all ps >  0.05). Besides age, baseline IQCODE (attention: –0.218 SD/y, executive function: –0.238 SD/y, visual memory: –0.266 SD/y), and MoCA improvement within 1 year (visuoconstruction: 0.007 SD/y, verbal memory: 0.012 SD/y) were associated with longitudinal cognitive changes. Baseline MoCA (OR = 0.66, 95% CI = [0.59–0.74]), MoCA improvement within 3–6 months (OR = 0.79, 95% CI = [0.71–0.89], and within 1 year (OR = 0.86, 95% CI = [0.76–0.96]) were associated with long-term PSCI, while baseline MoCA (OR = 0.76, 95% CI = [0.61–0.96]) was also associated with incident PSCI. Conclusion: While most domains remained stable across-time, visual memory demonstrated an overall improvement. Short-term cognitive improvement could be an early indicator of long-term cognitive trajectory to identify individuals who may be resilient to PSCI.

scholarly journals Does Abnormal Circadian Blood Pressure Pattern Really Matter in Patients With Transient Ischemic Attack or Minor Stroke?

Stroke ◽  
2014 ◽  
Vol 45 (3) ◽  
pp. 865-867 ◽  
Author(s):  
WenWen Zhang ◽  
Dominique A. Cadilhac ◽  
Leonid Churilov ◽  
Geoffrey A. Donnan ◽  
Christopher O’Callaghan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Transient Ischemic Attack ◽  
Minor Stroke ◽  
Pressure Pattern ◽  
Circadian Blood Pressure ◽  
Ischemic Attack

Abstract TP438: Japanese versus Non-Japanese Patients With Transient Ischemic Attack or Minor Stroke: Five-Year Risk of Stroke and Vascular Events

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Shinichiro Uchiyama ◽  
Takao Hoshino ◽  
Hugo Charles ◽  
Kenji Kamiyama ◽  
Taizen Nakase ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Transient Ischemic Attack ◽  
Japanese Patients ◽  
Minor Stroke ◽  
Stroke Recurrence ◽  
Large Artery ◽  
Vascular Events ◽  
Minor Ischemic Stroke ◽  
Ischemic Attack

Background: We have reported 5-year risk of stroke and vascular events after a transient ischemic attack (TIA) or minor ischemic stroke in patients enrolled into the TIAregistry.org, which was an international multicenter-cooperative, prospective registry (N Engl J Med 2018;378:2182-90). We conducted subanalysis on the 5-year follow-up data of Japanese patients in comparison with non-Japanese patients. Methods: The patients were classified into two groups on ethnicity, Japanese (n=345) and non-Japanese (n=3502), and their 5-year event rates were compared. We also determined predictors of five-year stroke in both groups. Results: Death from vascular cause (0.9% vs 2.7%, HR 0.28, 95% CI 0.09-0.89, p=0.031) and death from any cause (7.8% vs 9.9%, HR 0.67, 95% CI 0.45-0.99, p=0.045) were fewer in Japanese patients than in non-Japanese patients, while stroke (13.9% vs 7.2%, HR 1.78, 95% CI 1.31-2.43, p<0.001) and intracranial hemorrhage (3.2% vs 0.8%, HR 3.61. 95% CI 1.78-7.30, p<0.001) were more common in Japanese than non-Japanese patients during five-year follow-up period. Caplan-Meyer curves at five-years showed that the rates of stroke was also significantly higher in Japanese than non-Japanese patients (log-rank test, p=0.001). Predictors for stroke recurrence at five years were large artery atherosclerosis (HR 1.81, 95% CI 1.31-2.52, p<0.001), cardioembolism (HR 1.71, 95% CI 1.18-2.47, p=0.004), multiple acute infarction (HR 1.77, 95% CI 1.27-2.45, p<0.001) and ABCD 2 score 6 or 7 (HR 1.96, 95% CI 1.38-2.78, p<0.001) in non-Japanese patients, although only large artery atherosclerosis (HR 3.28, 95% CI 1.13-9.54, p=0.029) was a predictor for stroke recurrence in Japanese patients. Conclusions: Recurrence of stroke and intracranial hemorrhage were more prevalent in Japanese than non-Japanese patients. Large artery atherosclerosis was a predictor for stroke recurrence not only in non-Japanese patients but also in Japanese patients.

scholarly journals Simultaneous Bilateral Carotid Stenting under the Circumstance of Neuroprotection Device

2006 ◽  
Vol 12 (2) ◽  
pp. 141-148 ◽  
Author(s):  
Y.H. Lee ◽  
T.-K. Kim ◽  
S.-I. Suh ◽  
B.J. Kwon ◽  
T.H. Lee ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Carotid Stenting ◽  
Neurological Impairment ◽  
Hemodynamic Instability ◽  
Minor Stroke ◽  
Procedure Time ◽  
Hyperperfusion Syndrome ◽  
Bilateral Carotid ◽  
Ischemic Attack ◽  
Second Procedure

In this study, in order to evaluate the feasibility and outcomes of simultaneous bilateral carotid artery stenting (CAS) with the use of neuroprotection in symptomatic patients, we conducted a retrospective analysis of 27 patients (19 men, eight women; median age, 69.2 years), all of whom had been scheduled to undergo bilateral CAS in a single setting. All patients presented with severe atherosclerotic bilateral carotid stenosis (>50% for symptomatic side, >80% for asymptomatic side), exhibiting symptoms of either a cerebrovascular accident or of a transient ischemic attack on at least one side. 48 arteries were treated with self-expandable stents. Neuroprotection devices were utilized for bilateral CAS in 11 patients, and in 16 unilateral CAS patients. We did not perform the second procedure in six patients, in cases in which a patient exhibited (a) hemodynamic instability, (b) a new neurological impairment, or (c) restlessness after a prolonged time for the first CAS. The second procedure was postponed in a staged manner. We achieved a mean residual stenosis of 8.1 ± 5.0 % in the treated lesions. The mean procedural time for bilateral CAS was three hours and 18 minutes. 17 patients (63%) developed transient bradycardia during the balloon dilatation of one or both of the relevant arteries. Three patients (11%) exhibited persistent bradycardia and hypotension, which required the administration of intravenous vasopressors for several days (2!7 days). None of the patients ultimately required pacemakers, or any further therapy. Two of the patients (7%) developed transient ischemic attack during the periprocedural period, but recovered completely. One patient developed a new minor stroke after the first procedure, and the second procedure was delayed in a staged manner. We observed no periprocedural deaths, major strokes, or myocardial infarctions, nor did we detect any cases of hyperperfusion syndrome within 30 days. In summary, simultaneous bilateral CAS with neuroprotection can be performed in a single setting without increased concerns with regard to hyperperfusion syndrome, hemodynamic instability, thrombo-embolism, or procedure time, when the first CAS has been safely completed with no evidence of complications in a well-managed procedure time.

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