scholarly journals Clinical, Laboratory, and Imaging Characteristics of Transient Ischemic Attack Caused by Large Artery Lesions: A Comparison between Carotid and Intracranial Arteries

2015 ◽  
Vol 5 (3) ◽  
pp. 115-123 ◽  
Author(s):  
Toshiyuki Uehara ◽  
Tomoyuki Ohara ◽  
Kazunori Toyoda ◽  
Kazuyuki Nagatsuka ◽  
Kazuo Minematsu
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Transient Ischemic Attack ◽  
Clinical Laboratory ◽  
Stroke Care ◽  
Large Artery ◽  
Intracranial Artery ◽  
Imaging Characteristics ◽  
Artery Disease ◽  
Ischemic Attack

Background/Aims: The aims of this study were to determine the differences in clinical characteristics and the risk of ischemic stroke between patients with transient ischemic attack (TIA) attributable to extracranial carotid and intracranial artery occlusive lesions. Methods: Among 445 patients admitted to our stroke care unit within 48 h of TIA onset between April 2008 and December 2013, 85 patients (63 men, mean age 69.4 years) with large artery occlusive lesions relevant to symptoms were included in this study. The primary endpoints were ischemic stroke at 2 and 90 days after TIA onset. Results: Twenty-eight patients had carotid artery occlusive lesions (extracranial group), and 57 patients had intracranial artery occlusive lesions (intracranial group). Patients in the intracranial group were significantly younger, had lower levels of fibrinogen, and were less likely to have occlusion when compared with those in the extracranial group. Eleven patients in the extracranial group and none in the intracranial group underwent revascularization procedures within 90 days of TIA onset. The 2-day risk (14.2 vs. 0%, p = 0.044) and the 90-day risk (17.1 vs. 0%, p = 0.020) of ischemic stroke after TIA onset were significantly higher in the intracranial group than in the extracranial group. Conclusions: Among our patients with TIA caused by large artery disease, patients with intracranial artery occlusive lesions were more frequent and were at higher risk of early ischemic stroke than those with extracranial carotid artery occlusive lesions. These data highlight the importance of prompt assessment of intracranial artery lesions in patients with TIA.

Abstract WP136: Clinical, Laboratory, and Imaging Characteristics Oof Transient Ischemic Attack Caused by Large Artery Lesion: A Comparison Between Carotid and Intracranial Artery

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Toshiyuki Uehara ◽  
Tomoyuki Ohara ◽  
Kazuyuki Nagatsuka ◽  
Kazunori Toyoda ◽  
Kazuo Minematsu
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Transient Ischemic Attack ◽  
Clinical Laboratory ◽  
Stroke Care ◽  
Large Artery ◽  
Intracranial Artery ◽  
Imaging Characteristics ◽  
Artery Disease ◽  
Ischemic Attack

Background: The purpose of this study was to determine the differences in clinical characteristics and the risk of ischemic stroke between patients with transient ischemic attack (TIA) attributable to extracranial carotid and intracranial artery occlusive lesions. Methods: Among 445 patients admitted to our stroke care unit within 48 hours of TIA onset between April 2008 and December 2013, 85 patients (63 men, 69.4 years) with large artery occlusive lesions relevant to symptoms were included in this study. The primary endpoints were ischemic stroke at 2 days and 90 days after TIA onset. Results: Twenty-eight patients had carotid artery occlusive lesions (extracranial group), and 57 patients had intracranial artery occlusive lesions (intracranial group). Patients in the intracranial group were significantly younger, had lower levels of fibrinogen, and were less likely to have occlusion when compared to those in the extracranial group. Eleven patients in the extracranial group and no patient in the intracranial group underwent revascularization procedures within 90 days of TIA onset. The 2-day risk (14.2% vs. 0%, p = 0.044) and 90-day risk (17.1% vs. 0%, p = 0.020) of ischemic stroke after TIA onset were significantly higher in the intracranial group than in the extracranial group. Conclusions: Patients with intracranial artery occlusive lesions were more frequent and were at higher risk of early ischemic stroke than those with extracranial carotid artery occlusive lesions among our patients with TIA caused by large artery disease. These data highlight the importance of prompt assessment of intracranial artery lesions in patients with TIA.

Incidence, predictors, and etiology of subsequent ischemic stroke within one year after transient ischemic attack

2016 ◽  
Vol 12 (1) ◽  
pp. 84-89 ◽  
Author(s):  
Toshiyuki Uehara ◽  
Kazuo Minematsu ◽  
Tomoyuki Ohara ◽  
Kazumi Kimura ◽  
Yasushi Okada ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Large Artery ◽  
Intracranial Artery ◽  
Vessel Occlusion ◽  
Artery Disease ◽  
One Year ◽  
Ischemic Attack ◽  
The One ◽  
First 90 Days

Background Incidence and predictors of ischemic stroke in patients with transient ischemic attack (TIA) have not been fully clarified outside Europe and North America. Aims We undertook the present prospective, multicenter study to clarify the incidence, predictors, and etiology of ischemic stroke within one year of TIA onset in Japan. Methods The study subjects were patients within seven days of TIA onset who were enrolled in a prospective register from 57 hospitals between June 2011 and December 2013. The primary endpoint was occurrence of ischemic stroke. Results Of 1365 consecutive patients, 1245 were followed for one year after TIA onset; 101 (8.1%) experienced ischemic stroke during follow-up. The leading subtype of ischemic stroke was small-vessel occlusion (SVO) followed by large-artery atherosclerosis (LAA) attributable to intracranial artery diseases. When dividing ischemic stroke events between those occurring within the first 90 days after TIA onset and those occurring after the first 90 days, the leading subtype of ischemic stroke within the first 90 days after TIA onset was SVO, followed by LAA attributable to intracranial artery diseases. In comparison, the subtypes most commonly seen beyond the first 90 days after TIA onset were cardioembolic and LAA attributable to intracranial artery disease. The one-year risk of ischemic stroke increased significantly as ABCD2 score increased, at 6.2% for 0–3 points, 7.2% for 4–5 points, and 11.6% for 6–7 points. Conclusions The one-year ischemic stroke risk after TIA was about 8% and was associated with the ABCD2 score. The most common subtype of subsequent ischemic stroke was SVO.

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.

EXPRESS: Evolving Ischemic Stroke Subtypes in 15 years: A hospital-based observational study

2021 ◽  
pp. 174749302110059
Author(s):  
Yiu Ming Bonaventure Ip ◽  
Lisa Au ◽  
Yin Yan Anne Chan ◽  
Florence Fan ◽  
Hing Lung Ip ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Recurrence Rate ◽  
Small Vessel Disease ◽  
Mainland China ◽  
Cardioembolic Stroke ◽  
Large Artery ◽  
Risk Factor Control ◽  
Stroke Subtypes ◽  
Artery Disease ◽  
Ischemic Attack

Background: Depicting the time trends of ischemic stroke subtypes may inform healthcare resource allocation on etiology-based stroke prevention and treatment. Aim: To reveal the evolving ischemic stroke subtypes from 2004 to 2018. Methods: We determined the stroke etiology of consecutive first-ever transient ischemic attack or ischemic stroke patients admitted to a regional hospital in Hong Kong from 2004 to 2018. We analyzed the age-standardized incidences and the 2-year recurrence rate of major ischemic stroke subtypes. Results: Among 6940 patients admitted from 2004 to 2018, age-standardized incidence of ischemic stroke declined from 187.0 to 127.4 per 100,000 population (p<0.001), driven by the decrease in large artery disease (43.0 to 9.67 per 100,000 population (p<0.001)) and small vessel disease (71.9 to 45.7 per 100,000 population (p<0.001)). Age-standardized incidence of cardioembolic stroke did not change significantly (p=0.2). Proportion of cardioembolic stroke increased from 20.4% in 2004-2006 to 29.3% in 2016-2018 (p<0.001). 2-year recurrence rate of intracranial atherothrombotic stroke reduced from 19.3% to 5.1% (p<0.001) with increased prescriptions of statin (p<0.001) and dual anti-platelet therapy (<0.001). In parallel with increased anticoagulation use across the study period (p<0.001), the 2-year recurrence of AF-related stroke reduced from 18.9% to 6% (p<0.001). Conclusion: Etiology-based risk factor control might have led to the diminishing stroke incidences related to atherosclerosis. To tackle the surge of AF-related strokes, arrhythmia screening, anticoagulation usage and mechanical thrombectomy service should be reinforced. Comparable preventive strategies might alleviate the enormous stroke burden in mainland China.

scholarly journals Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018

2018 ◽  
Vol 13 (9) ◽  
pp. 949-984 ◽  
Author(s):  
JM Boulanger ◽  
MP Lindsay ◽  
G Gubitz ◽  
EE Smith ◽  
G Stotts ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Transient Ischemic Attack ◽  
Best Practice ◽  
Stroke Care ◽  
Stroke Management ◽  
Practice Recommendations ◽  
Prehospital Emergency ◽  
Ischemic Attack

The 2018 update of the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of acute stroke or transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for ischemic stroke, and acute inpatient care. The most notable changes included in this 6th edition are the renaming of the module and its integration of the formerly separate modules on prehospital and emergency care and acute inpatient stroke care. The new module, Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care is now a single, comprehensive module addressing the most important aspects of acute stroke care delivery. Other notable changes include the removal of two sections related to the emergency management of intracerebral hemorrhage and subarachnoid hemorrhage. These topics are covered in a new, dedicated module, to be released later this year. The most significant recommendation updates are for neuroimaging; the extension of the time window for endovascular thrombectomy treatment out to 24 h; considerations for treating a highly selected group of people with stroke of unknown time of onset; and recommendations for dual antiplatelet therapy for a limited duration after acute minor ischemic stroke and transient ischemic attack. This module also emphasizes the need for increased public and healthcare provider’s recognition of the signs of stroke and immediate actions to take; the important expanding role of paramedics and all emergency medical services personnel; arriving at a stroke-enabled Emergency Department without delay; and launching local healthcare institution code stroke protocols. Revisions have also been made to the recommendations for the triage and assessment of risk of recurrent stroke after transient ischemic attack/minor stroke and suggested urgency levels for investigations and initiation of management strategies. The goal of this updated guideline is to optimize stroke care across Canada, by reducing practice variations and reducing the gap between current knowledge and clinical practice.

scholarly journals Essen Risk Score in Prediction of Myocardial Infarction After Transient Ischemic Attack or Ischemic Stroke Without Prior Coronary Artery Disease

Stroke ◽  
2019 ◽  
Vol 50 (12) ◽  
pp. 3393-3399 ◽  
Author(s):  
Marion Boulanger ◽  
Linxin Li ◽  
Shane Lyons ◽  
Nicola G. Lovett ◽  
Magdalena M. Kubiak ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Ischemic Stroke ◽  
Coronary Artery ◽  
Risk Score ◽  
Transient Ischemic Attack ◽  
Artery Disease ◽  
Ischemic Attack

scholarly journals High ABCD2 Scores and In-Hospital Interventions following Transient Ischemic Attack

2016 ◽  
Vol 6 (3) ◽  
pp. 76-83 ◽  
Author(s):  
Shawna Cutting ◽  
Elizabeth Regan ◽  
Vivien H. Lee ◽  
Shyam Prabhakaran
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Heart Association ◽  
Reperfusion Therapy ◽  
Large Artery ◽  
Increased Risk ◽  
Risk Patients ◽  
Abcd2 Score ◽  
Ischemic Attack ◽  
Ischemic Events

Background and Purpose: Following transient ischemic attack (TIA), there is increased risk for ischemic stroke. The American Heart Association recommends admission of patients with ABCD2 scores ≥3 for observation, rapid performance of diagnostic tests, and potential acute intervention. We aimed to determine if there is a relationship between ABCD2 scores, in-hospital ischemic events, and in-hospital treatments after TIA admission. Methods: We reviewed consecutive patients admitted between 2006 and 2011 following a TIA, defined as transient focal neurological symptoms attributed to a specific vascular distribution and lasting <24 h. Three interventions were prespecified: anticoagulation for atrial fibrillation, carotid or intracranial revascularization, and intravenous or intra-arterial reperfusion therapies. We compared rates of in-hospital recurrent TIA or ischemic stroke and the receipt of interventions among patients with low (<3) versus high (≥3) ABCD2 scores. Results: Of 249 patients, 11 patients (4.4%) had recurrent TIAs or strokes during their stay (8 TIAs, 3 strokes). All 11 had ABCD2 scores ≥3, and no neurological events occurred in patients with lower scores (5.1 vs. 0%; p = 0.37). Twelve patients (4.8%) underwent revascularization for large artery stenosis, 16 (6.4%) were started on anticoagulants, and no patient received intravenous or intra-arterial reperfusion therapy. The ABCD2 score was not associated with anticoagulation (p = 0.59) or revascularization (p = 0.20). Conclusions: Higher ABCD2 scores may predict early ischemic events after TIA but do not predict the need for intervention. Outpatient evaluation for those with scores <3 would potentially have delayed revascularization or anticoagulant treatment in nearly one-fifth of ‘low-risk' patients.

scholarly journals Residual Inflammatory Risk Predicts Poor Prognosis in Acute Ischemic Stroke or Transient Ischemic Attack Patients

Stroke ◽  
2021 ◽  
Author(s):  
Jiejie Li ◽  
Yuesong Pan ◽  
Jie Xu ◽  
Shiyu Li ◽  
Mengxing Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Large Artery ◽  
Poor Functional Outcome ◽  
Ischemic Attack

Background and Purpose: It is still unclear whether the residual cholesterol and inflammatory risk in the acute phase is associated with prognosis of stroke. We aimed to investigate the proportion and relative contribution of residual cholesterol and inflammatory risk, determined by baseline low-density lipoprotein cholesterol (LDL-C) and high-sensitivity C-reactive protein (hsCRP) levels, to the risk of recurrent stroke and poor functional outcome at 1 year. Methods: In this prospective multicenter cohort study, 10 499 consecutive acute ischemic stroke and transient ischemic attack patients with levels of LDL-C and hsCRP were enrolled. Patients were divided into 4 groups: residual cholesterol risk only (LDL-C ≥2.6 mmol/L and hsCRP <3 mg/L), residual inflammatory risk (RIR) only (LDL-C <2.6 mmol/L and hsCRP ≥3 mg/L), both risk (LDL-C ≥2.6 mmol/L and hsCRP ≥3 mg/L), and neither risk (LDL-C <2.6 mmol/L and hsCRP <3 mg/L). The primary outcomes consisted of stroke recurrence and a modified Rankin Scale score of 2 to 6 within 1 year. Results: The relative proportions of patients with RIR only, residual cholesterol risk only, both risk, and neither were 21.3%, 23.7%, 14.4%, and 40.6%, respectively. RIR only was independently associated with recurrent stroke (adjusted hazard ratio, 1.18 [95% CI, 1.00–1.40]; P =0.05). The association was slightly attenuated after further adjusting for usage of antiplatelet agent and statin during 1-year follow-up in addition to the traditional risk factors (hazard ratio, 1.31 [95% CI, 0.99–1.76]; P =0.07). When applying the LDL-C cutoff value of 1.8 mmol/L in the sensitivity analyses, such association in large-artery atherosclerosis subtype was more significant (adjusted hazard ratio, 1.69 [95% CI, 1.06–2.67]; P =0.03). Patients with RIR only also had increased risk of poor functional outcome (adjusted odds ratio, 1.43 [95% CI, 1.24–1.64]; P <0.0001). Conclusions: In the patients with acute ischemic stroke or transient ischemic attack, RIR only could be predictive for recurrent stroke, especially for those with large-artery atherosclerosis, and poor functional outcome.

Abstract W P203: Early Recurrence or Worsening of Transient Ischemic Attack or Minor Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Yasumasa Yamamoto ◽  
Yoshinari Nagakane ◽  
Naoki Makita ◽  
Shinji Ashida
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Early Recurrence ◽  
Stroke Subtype ◽  
Stroke Subtypes ◽  
Minor Ischemic Stroke ◽  
Artery Disease ◽  
Ischemic Attack ◽  
Total Event ◽  
Early Worsening

Purpose: The present study aimed to assess the rate of and predictors for early recurrence or worsening after transient ischemic attack (TIA) or minor ischemic stroke (MIS). Methods: From 1806 consecutive patients with acute ischemic stroke, 474 patients with TIA or MIS have been studied. MIS was defined by an NIH Stroke Scale (NIHSS) score ≤3. The primary outcome was total events that include new-onset stroke or TIA and early worsening in patients with MIS in the first 90 days. Worsening was defined as clinical deterioration by ≥2 points on the NIHSS. Patients were classified into 6 stroke subtypes, i.e., G1: Intracranial atherothrombotic (ATB) (n=53), G2: Extracranial ATB (34), G3: Cardioembolic (85), G4: Penetrating artery (PA) disease (200), G5: Coagulopathy (9), and G6: Other embolism included paradoxical (22), aortogenic (31) and cryptogenic (44) embolism. Patients were also classified into 4 groups in terms of diffusion weighted image (DWI) pattern, i.e., D1: Single cortical and subcortical (n=53), D2: Multiple cortical and subcortical (108), D3: Penetrating artery territory (209) and D4: None (90). Results: Penetrating artery disease as stroke subtype is most prevalent (42.1%). There were 83 total events, of those 65% were worsening. Higher NIHSS (≥2) at admission and positive DWI were significantly higher in the group with events than without (OR: 1.67, 2.39, respectively). Most worsening occurred within 6 days. The incidence of total events/ worsening in different stroke subtypes were G1: 13 (24.5%)/8 (15.0%), G2: 8 (23.4)/4 (11.7), G3: 13 (15.2)/ 8 (9.4), G4: 41 (20.5)/32 (16.0), G5: 2 (22.2) /1 (11.1), and G6: 6 (6.4) /3 (3.2). Total event were higher in G1, G2 and G4, and worsening were higher in G1 (60% of total events) and G4 (80%). The incidence of total events/ worsening in different DWI patterns were D1: 8 (11.9%)/5 (7.4%), D2: 21 (19.4)/14 (12.9), D3: 46 (22.0)/ 36 (17.2), D4: 8 (8.8)/0 (0). Total events were higher in D2 and D3, of those worsening was 66.6% in D2 and 78.2% in D3. Conclusions: A majority of events after TIA/MIS was worsening that is prevalent especially in the patients with intracranial ATB and PA disease and those with high DWI signals of multiple cortical and PA territory. A strategy to halt progressive stroke should be tailored.

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