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

Abstract

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.