BACKGROUND AND PURPOSE: The risk of recurrent stroke is highest within the first few weeks after a transient ischemic attack (TIA), and it is likely to be related to the underlying pathology. We sought to study the early risk of recurrent stroke by etiologic subtype. METHODS: We prospectively studied 388 TIA patients. The cause of TIA was classified according to the Trial of ORG 10172 criteria: large-artery atherosclerosis (LAA, n=90), cardioembolism (n=87), small-vessel disease (n=68), undetermined (n=127), and other determined cause (n=16). Patients were followed up at 3 months. Risk factors and clinical symptoms for each subtype were recorded. RESULTS: The duration of symptoms and clinical symptoms varied significantly among the different subtypes. LAA was associated with recurrent short episodes of weakness, whereas speech impairment and cortical symptoms were associated with cardioembolism (P<0.05). The association of vascular risk factors was highest in LAA (P<0.05). New strokes were recorded in 35 (9%) patients. Recurrent stroke risk varied among subtypes (P<0.001): LAA, 20.0%; cardioembolism, 11.5%; undetermined, 4.7%; small-vessel disease, 1.5%; and other cause, 0%. Cox proportional-hazards multivariate analyses did not identify any independent predictor of further cerebral ischemic events for LAA, cardioembolism, undetermined, or small-vessel disease. CONCLUSIONS: The risk of early recurrent stroke is highest in patients with LAA. This supports the need for urgent carotid and transcranial imaging for identifying those patients at highest risk. Some risk factors and clinical symptoms are related to some etiologic subtypes, but stronger predictors of stroke recurrence are needed to identify those patients with highest risk for each TIA subtype.
BACKGROUND AND PURPOSE: The risk of recurrent stroke is highest within the first few weeks after a transient ischemic attack (TIA), and it is likely to be related to the underlying pathology. We sought to study the early risk of recurrent stroke by etiologic subtype. METHODS: We prospectively studied 388 TIApatients. The cause of TIA was classified according to the Trial of ORG 10172 criteria: large-artery atherosclerosis (LAA, n=90), cardioembolism (n=87), small-vessel disease (n=68), undetermined (n=127), and other determined cause (n=16). Patients were followed up at 3 months. Risk factors and clinical symptoms for each subtype were recorded. RESULTS: The duration of symptoms and clinical symptoms varied significantly among the different subtypes. LAA was associated with recurrent short episodes of weakness, whereas speech impairment and cortical symptoms were associated with cardioembolism (P<0.05). The association of vascular risk factors was highest in LAA (P<0.05). New strokes were recorded in 35 (9%) patients. Recurrent stroke risk varied among subtypes (P<0.001): LAA, 20.0%; cardioembolism, 11.5%; undetermined, 4.7%; small-vessel disease, 1.5%; and other cause, 0%. Cox proportional-hazards multivariate analyses did not identify any independent predictor of further cerebral ischemic events for LAA, cardioembolism, undetermined, or small-vessel disease. CONCLUSIONS: The risk of early recurrent stroke is highest in patients with LAA. This supports the need for urgent carotid and transcranial imaging for identifying those patients at highest risk. Some risk factors and clinical symptoms are related to some etiologic subtypes, but stronger predictors of stroke recurrence are needed to identify those patients with highest risk for each TIA subtype.
Authors: Francesco Blasi; Bruno L Oliveira; Tyson A Rietz; Nicholas J Rotile; Pratap C Naha; David P Cormode; David Izquierdo-Garcia; Ciprian Catana; Peter Caravan Journal: Arterioscler Thromb Vasc Biol Date: 2015-08-13 Impact factor: 8.311
Authors: Joanna M Wardlaw; Miriam Brazzelli; Francesca M Chappell; Hector Miranda; Kirsten Shuler; Peter A G Sandercock; Martin S Dennis Journal: Neurology Date: 2015-07-01 Impact factor: 9.910
Authors: Mandy D Müller; Stefanie von Felten; Ale Algra; Jean-Pierre Becquemin; Richard Bulbulia; David Calvet; Hans-Henning Eckstein; Gustav Fraedrich; Alison Halliday; Jeroen Hendrikse; George Howard; John Gregson; Olav Jansen; Martin M Brown; Jean-Louis Mas; Thomas G Brott; Peter A Ringleb; Leo H Bonati Journal: Circ Cardiovasc Interv Date: 2019-08-05 Impact factor: 6.546
Authors: Judith H Lichtman; Sara B Jones; Emi Watanabe; Norrina B Allen; Yun Wang; Virginia J Howard; Larry B Goldstein Journal: Stroke Date: 2009-02-19 Impact factor: 7.914