scholarly journals Sex-Related Differences in Clinical Features, Neuroimaging, and Long-Term Prognosis After Transient Ischemic Attack

Stroke ◽  
2021 ◽  
Vol 52 (2) ◽  
pp. 424-433
Author(s):  
Francisco Purroy ◽  
Mikel Vicente-Pascual ◽  
Gloria Arque ◽  
Mariona Baraldes-Rovira ◽  
Robert Begue ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Odds Ratio ◽  
Diffusion Weighted Imaging ◽  
Hazard Ratio ◽  
Large Artery ◽  
Vascular Events ◽  
Diffusion Weighted ◽  
Long Term Prognosis ◽  
Ischemic Attack

Background and Purpose: Differences in sex in the incidence, presentation, and outcome of events after ischemic stroke have been studied in depth. In contrast, only limited data are available after transient ischemic attack (TIA). We aim to assess sex-related differences in the presentation, cause, neuroimaging features, and predictors of long-term prognosis in patients with TIA. Methods: We carried out a prospective cohort study of consecutive patients with TIA from January 2006 to June 2010. Nondefinitive TIA events were defined by the presence of isolated atypical symptoms. The risk of stroke recurrence (SR) and composite of major vascular events were stratified by sex after a median follow-up time of 6.5 (interquartile range, 5.0–9.6) years. Results: Among the 723 patients studied, 302 (41.8%) were female and 79 (10.9%) suffered a nondefinitive TIA event. Vascular territory diffusion-weighted imaging patterns (odds ratio, 1.61 [95% CI, 0.94–2.77]), and nondefinitive TIA events (odds ratio, 2.66 [95% CI, 1.55–4.59]) were associated with women, whereas active smoking (odds ratio, 0.30 [95% CI, 0.15–0.58]) and large artery atherosclerosis causes (odds ratio, 0.50 [95% CI, 0.29–0.83]) were related to men. The risk of SR was similar in both sexes (12.6% [95% CI, 8.9–16.3] for women versus 14.3% [95% CI, 11.0–17.6] for men). In contrast, the risk of major vascular events was significantly lower in women than in men (17.5% [95% CI, 13.2–21.8] versus 23.8% [95% CI, 19.7–27.9]). In both sexes, after adjusting for age, large artery atherosclerosis was associated with SR (hazard ratio, 3.22 [95% CI, 1.42–7.24] and hazard ratio, 2.00 [95% CI, 1.14–3.51]). In a Kaplan-Meier analysis, females with positive diffusion-weighted imaging ( P =0.014) and definitive TIA (log-rank test P =0.022) had a significantly higher risk of SR. Conclusions: Despite similar risks of SR, there were sex-related differences in baseline characteristics, presenting symptoms, patterns of acute ischemic lesions, cause, and outcomes. These findings encourage further research into optimal preventive strategies that take into account these differences.

scholarly journals Higher Risk of Further Vascular Events Among Transient Ischemic Attack Patients With Diffusion-Weighted Imaging Acute Ischemic Lesions

Stroke ◽  
2004 ◽  
Vol 35 (10) ◽  
pp. 2313-2319 ◽  
Author(s):  
Francisco Purroy ◽  
Joan Montaner ◽  
Álex Rovira ◽  
Pilar Delgado ◽  
Manuel Quintana ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Diffusion Weighted Imaging ◽  
Vascular Events ◽  
Diffusion Weighted ◽  
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 Role of Perfusion-Weighted Imaging in a Diffusion-Weighted-Imaging-Negative Transient Ischemic Attack

2017 ◽  
Vol 13 (2) ◽  
pp. 129 ◽  
Author(s):  
Sang Hun Lee ◽  
Hyun Wook Nah ◽  
Bum Joon Kim ◽  
Sung Ho Ahn ◽  
Jong S. Kim ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Diffusion Weighted Imaging ◽  
Perfusion Weighted Imaging ◽  
Diffusion Weighted ◽  
Ischemic Attack

scholarly journals High‐resolution diffusion‐weighted imaging identifies ischemic lesions in a majority of transient ischemic attack patients

2019 ◽  
Vol 86 (3) ◽  
pp. 452-457 ◽  
Author(s):  
Benjamin Hotter ◽  
Ivana Galinovic ◽  
Claudia Kunze ◽  
Peter Brunecker ◽  
Gerhard J. Jungehulsing ◽  
...  
Keyword(s):  
High Resolution ◽  
Transient Ischemic Attack ◽  
Diffusion Weighted Imaging ◽  
Diffusion Weighted ◽  
Ischemic Attack

scholarly journals Antiplatelet Therapy After Noncardioembolic Stroke

Stroke ◽  
2019 ◽  
Vol 50 (7) ◽  
pp. 1812-1818 ◽  
Author(s):  
Jacoba P. Greving ◽  
Hans-Christoph Diener ◽  
Johannes B. Reitsma ◽  
Philip M. Bath ◽  
László Csiba ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Major Bleeding ◽  
Transient Ischemic Attack ◽  
Clinical Benefit ◽  
Antiplatelet Agents ◽  
Vascular Events ◽  
Subgroup Analyses ◽  
Ischemic Attack ◽  
Net Clinical Benefit

Background and Purpose— We assessed the efficacy and safety of antiplatelet agents after noncardioembolic stroke or transient ischemic attack and examined how these vary according to patients’ demographic and clinical characteristics. Methods— We did a network meta-analysis (NMA) of data from 6 randomized trials of the effects of commonly prescribed antiplatelet agents in the long-term (≥3 months) secondary prevention of noncardioembolic stroke or transient ischemic attack. Individual patient data from 43 112 patients were pooled and reanalyzed. Main outcomes were serious vascular events (nonfatal stroke, nonfatal myocardial infarction, or vascular death), major bleeding, and net clinical benefit (serious vascular event or major bleeding). Subgroup analyses were done according to age, sex, ethnicity, hypertension, qualifying diagnosis, type of vessel involved (large versus small vessel disease), and time from qualifying event to randomization. Results— Aspirin/dipyridamole combination (RR NMA-adj , 0.83; 95% CI, 0.74–0.94) significantly reduced the risk of vascular events compared with aspirin, as did clopidogrel (RR NMA-adj , 0.88; 95% CI, 0.78–0.98), and aspirin/clopidogrel combination (RR NMA-adj , 0.83; 95% CI, 0.71–0.96). Clopidogrel caused significantly less major bleeding and intracranial hemorrhage than aspirin, aspirin/dipyridamole combination, and aspirin/clopidogrel combination. Aspirin/clopidogrel combination caused significantly more major bleeding than aspirin, aspirin/dipyridamole combination, and clopidogrel. Net clinical benefit was similar for clopidogrel and aspirin/dipyridamole combination (RR NMA-adj , 0.99; 95% CI, 0.93–1.05). Subgroup analyses showed no heterogeneity of treatment effectiveness across prespecified subgroups. The excess risk of major bleeding associated with aspirin/clopidogrel combination compared with clopidogrel alone was higher in patients aged <65 years than it was in patients ≥65 years (RR NMA-adj , 3.9 versus 1.7). Conclusions— Results favor clopidogrel and aspirin/dipyridamole combination for long-term secondary prevention after noncardioembolic stroke or transient ischemic attack, regardless of patient characteristics. Aspirin/clopidogrel combination was associated with a significantly higher risk of major bleeding compared with other antiplatelet regimens.

scholarly journals Optimal Timing of Diffusion-Weighted Imaging to Avoid False-Negative Findings in Patients With Transient Ischemic Attack

Stroke ◽  
2017 ◽  
Vol 48 (7) ◽  
pp. 1990-1992 ◽  
Author(s):  
Kenji Shono ◽  
Junichiro Satomi ◽  
Yoshiteru Tada ◽  
Yasuhisa Kanematsu ◽  
Nobuaki Yamamoto ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Diffusion Weighted Imaging ◽  
False Negative ◽  
Optimal Timing ◽  
Diffusion Weighted ◽  
Negative Findings ◽  
Ischemic Attack

White matter hyperintensity volume predicts persistent cognitive impairment in transient ischemic attack and minor stroke

2016 ◽  
Vol 12 (3) ◽  
pp. 264-272 ◽  
Author(s):  
Leka Sivakumar ◽  
Parnian Riaz ◽  
Mahesh Kate ◽  
Thomas Jeerakathil ◽  
Christian Beaulieu ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
White Matter ◽  
Transient Ischemic Attack ◽  
Cognitive Assessment ◽  
Diffusion Weighted Imaging ◽  
Montreal Cognitive Assessment ◽  
White Matter Hyperintensity ◽  
Minor Stroke ◽  
Diffusion Weighted ◽  
Ischemic Attack

Background Temporary and permanent cognitive changes following transient ischemic attack/minor stroke have been described previously. It is unknown if persisting cognitive deficits in these patients are correlated with acute infarction identified using magnetic resonance imaging. Aims We tested the hypothesis that persistent cognitive impairment after transient ischemic attack/minor stroke can be predicted by the volume of diffusion-weighted imaging lesions. Methods Acute transient ischemic attack/minor stroke (NIH stroke scale score ≤ 3) patients were prospectively recruited within 72 h of onset. Patients underwent Montreal cognitive assessment and magnetic resonance imaging, including diffusion-weighted imaging and Fluid-Attenuated Inverse Recovery sequences, at baseline, days 7 and 30. Cognitive testing was repeated at day 90. Diffusion-weighted imaging lesion and Fluid-Attenuated Inverse Recovery chronic white matter hyperintensity volumes were measured planimetrically. Cognitive impairment was defined a priori as Montreal cognitive assessment score < 26. Results One hundred fifteen patients were imaged at a median (inter-quartile range) of 24.0 (16.6) h after onset. Acute ischemic lesions were present in 91 (79%) patients. Cognitive impairment rates were similar in patients with (47/91, 52%) and without diffusion-weighted imaging lesions (13/24, 54%; p = 0.83). Although linear regression indicated no relationship between acute diffusion-weighted imaging lesion volume and day 30 Montreal cognitive assessment scores (β = −0.163, [−2.243, 0.334], p = 0.144), white matter hyperintensity volumes at baseline were predictive of persistent cognitive deficits after 30 days (β = 2.24, [1.956, 45.369], p = 0.005). Conclusions In most transient ischemic attack/minor stroke patients who suffer acute cognitive impairment post event, deficits are temporary. Deficits after 30 days of onset are correlated with chronic white matter hyperintensity, suggesting subclinical cognitive impairment and/or impaired ability to compensate for the effects of acute ischemic infarcts.

scholarly journals The ABCD and ABCD2 Scores and the Risk of Stroke following a TIA: A Narrative Review

2011 ◽  
Vol 2011 ◽  
pp. 1-12 ◽  
Author(s):  
Archit Bhatt ◽  
Vishal Jani
Keyword(s):  
Atrial Fibrillation ◽  
Diffusion Weighted Imaging ◽  
Prognostic Value ◽  
Risk Scores ◽  
Large Artery ◽  
Imaging Data ◽  
Short Term ◽  
Vascular Events ◽  
Diffusion Weighted ◽  
Abcd2 Score

The California, ABCD, and ABCD2 risk scores (ABCD system) were developed to help stratify short-term stroke risk in patients with TIA (transient ischemic attack). Beyond this scope, the ABCD system has been extensively used to study other prognostic information such as DWI (diffusion-weighted imaging) abnormalities, large artery stenosis, atrial fibrillation and its diagnostic accuracy in TIA patients, which are independent predictors of subsequent stroke in TIA patients. Our comprehensive paper suggested that all scores have and equivalent prognostic value in predicting short-term risk of stroke; however, the ABCD2 score is being predominantly used at most centers. The majority of studies have shown that more than half of the strokes in the first 90 days, occur in the first 7 days. The majority of patients studied were predominantly classified to have a higher ABCD/ABCD2 > 3 scores and were particularly at a higher short-term risk of stroke or TIA and other vascular events. However, patients with low risk ABCD2 score < 4 may have high-risk prognostic indicators, such as diffusion weighted imaging (DWI) abnormalities, large artery atherosclerosis (LAA), and atrial fibrillation (AF). The prognostic value of these scores improved if used in conjunction with clinical information, vascular imaging data, and brain imaging data. Before more data become available, the diagnostic value of these scores, its applicability in triaging patients, and its use in evaluating long-term prognosis are rather secondary; thus, indicating that the primary significance of these scores is for short-term prognostic purposes.

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