Days Of Transient Ischemic Attack Research Articles

Diagnostic value of ABCD2 and ABCD3-I risk scoring systems in determining one-month risk of stroke in patients with transient ischemic attack: An observational study

Objective: To compare the diagnostic value of the ABCD2 and ABCD3-I scoring systems in predicting the development of a 30-day neurological event in adult patients with transient ischemic attack (TIA) presenting to the emergency department. Methods: The study was observational and prospective and was conducted in a single center. The diagnostic values of the ABCD2 and ABCD3-I scores in predicting a neurological event within one month were compared in patients diagnosed with TIA in the emergency department. Results: A statistically significant difference was observed between groups with or without stroke within one month in terms of both the ABCD2 and ABCD3-I scores (P=0.044 and P=0.029, respectively). There was no statistically significant difference between the patients with and without a recurrent TIA within one month in relation to the ABCD2 score (P=0.934), but a statistically significant difference was found in the ABCD3-I scores of these groups (P<0.001). Conclusions: Both the ABCD2 and ABCD3-I scoring systems could predict ischemic stroke within 30 days of TIA, the ABCD3-I score is more effective than the ABCD2 score in the prediction of TIA recurrence.

Cerebrovascular Complication and Valve Surgery in Infective Endocarditis.

Infective endocarditis (IE) with neurologic complications is common in patients with active IE. The most common and feared neurological complication of left-sided IE is cerebrovascular, from septic emboli causing ischemic stroke, intracranial hemorrhage (ICH), or an infectious intracranial aneurysm with or without rupture. In patients with cerebrovascular complications, valve replacement surgery is often delayed for concern of further neurological worsening. However, in circumstances when an indication for valve surgery to treat IE is present, the benefits of early surgical treatment may outweigh the potential neurologic deterioration. Furthermore, valve surgery has been associated with lower in-hospital mortality than medical therapy with intravenous antibiotics alone. Early valve surgery can be performed within 7 days of transient ischemic attack or asymptomatic stroke when medically indicated. Timing of valve surgery for IE after symptomatic medium or large symptomatic ischemic stroke or ICH remains challenging, and current data in the literature are conflicting about the risks and benefits. A delay of 2 to 4 weeks from the time of the cerebrovascular event is often recommended, balancing the risks and benefits of surgery. The range of timing of valve surgery varies depending on the clinical scenario, and is best determined by a multidisciplinary decision between cardiothoracic surgeons, cardiologists, infectious disease experts, and vascular neurologists in an experienced referral center.

Screening for cognitive impairment with the Montreal Cognitive Assessment in Spanish patients with minor stroke or transient ischaemic attack

ObjectiveThe symptoms of minor stroke and transient ischemic attack (TIA) are temporary and mild. Despite the transient nature of the focal symptoms and the absence of visible brain lesions in some patients, many experience persistent cognitive problems subsequently. We aimed to establish the discriminant capacity of the Montreal Cognitive Assessment (MoCA) in screening for cognitive impairment (CI) within 90 days of TIA. MethodsA total of 50 patients with minor stroke or TIA were recruited. Patients were administered the MoCA test and a formal neuropsychological test battery. CI was defined clinically according to neuropsychological test findings. ResultsThe average age of recruited patients was 57.7±8.0 years; 70.0% were men; all patients had completed at least primary education. Thirty-seven patients (74.0%) presented CI. Receiver operating characteristic curve analysis obtained an optimal MoCA cut-off point of 25 for discriminating between patients with CI and those without, with an area under the curve of 0.835 (95% confidence interval [CI], 0.720-0.949), sensitivity of 78.4% (95% CI, 62.8%-88.6%), specificity of 76.9% (95% CI, 49.7%-91.8%), positive predictive value of 90.6% (95% CI, 81.0%-95.6%), and negative predictive value of 55.6% (95% CI, 39.5%-70.4%). ConclusionsMore than half of the patients presented CI as determined by the formal battery of neuropsychological tests. A MoCA cut-off point of 25 is sufficiently sensitive and specific for detecting CI after minor stroke or TIA, and may be implemented as a screening technique in routine clinical practice.

Early Dabigatran Treatment After Transient Ischemic Attack and Minor Ischemic Stroke Does Not Result in Hemorrhagic Transformation.

The optimal timing of anticoagulation after ischemic stroke in atrial fibrillation (AF) patients is unknown. Our aim was to demonstrate the feasibility and safety of initiating dabigatran therapy within 14 days of transient ischemic attack (TIA) or minor stroke in AF patients. A prospective, multi-center registry (NCT02415855) in patients with AF treated with dabigatran within 14 days of acute ischemic stroke/TIA (National Institutes of Health Stroke Scale (NIHSS) ≤ 3) onset. Baseline and follow-up computed tomography (CT) scans were assessed for hemorrhagic transformation (HT) and graded by using European Cooperative Acute Stroke Study criteria. One hundred and one patients, with a mean age of 72.4 ± 11.5 years, were enrolled. Median infarct volume was 0 ml. Median time from index event onset to dabigatran initiation was 2 days, and median baseline NIHSS was 1. Pre-treatment HT was present in seven patients. No patients developed symptomatic HT. On the day 7 CT scan, HT was present in six patients (one progressing from baseline hemorrhagic infarction type 1). Infarct volume was a predictor of incident HT (odds ratio = 1.063 [1.020-1.107], p < 0.003). All six (100%) patients with new/progressive HT were functionally independent (modified Rankin Scale (mRS) = 0-2) at 30 days, which was similar to those without HT (90%, p = 0.422). Recurrent ischemic events occurred within 30 days in four patients, two of which were associated with severe disability and death (mRS 5 and 6, respectively). Early dabigatran treatment did not precipitate symptomatic HT after minor stroke. Asymptomatic HT was associated with larger baseline infarct volumes. Early recurrent ischemic events may be clinically more important.

Study on the risk prediction for cerebral infarction after transient ischemic attack: A STROBE compliant study.

Transient ischemic attack (TIA) is often recurrent, and about one-third of patients will progress to cerebral infarction. Rapidly identifying high-risk patients is pivotal to prevent the development of cerebral infarction. Therefore, this study aimed to evaluate the value of ABCD2 score, ABCD2 score combined with magnetic resonance diffusion weighted imaging (DWI) and intracranial arterial magnetic resonance angiography (MRA) in predicting cerebral infarction after 2 to 30 days of transient ischemic attack (TIA).182 patients with TIA from August 2011 to August 2014 were enrolled as study subjects, and their clinical data, test results of DWI and MRA were collected. The incidence of cerebral infarction was observed at 2 days, 7 days and 30 days after TIA in patients with TIA, through scoring according to the 7-point ABCD2 score method proposed by Johnston. The relationship between ABCD2 score, performances of DWI and MRA and the early incidence of cerebral infarction after TIA was analyzed. The accuracy rating of ABCD2 score and ABCD2 + DWI + MRA score used for predicting the early incidence of cerebral infarction after TIA were compared with each other.The incidence of cerebral infarction after TIA was 19 cases (10.4%) in 2 days, 42 cases (23.1%) in 7 days, 56 cases (30.8%) in 30 days respectively. For the ABCD2 score of incidence of cerebral infarction 2 to 30 days after TIA, that of those with high risk was higher than that with medium risk, and that with the medium risk was higher than that with low risk (P < .05). The area under the curve of ABCD2 + DWI + MRA score and ABCD2 score predicting the incidence of cerebral infarction was: in 2 days: 0.782 and 0.748, in 7 days: 0.839 and 0.801, in 30 days: 0.780 and 0.757, P < .05.Compared with ABCD2 score, ABCD2 score combined with DWI and MRA can further improve the accuracy of prediction for cerebral infarction after TIA.

Detección del deterioro cognitivo con la Evaluación Cognitiva de Montreal en pacientes españoles con ictus minor o ataque isquémico transitorio

ObjectiveThe symptoms of minor stroke and transient ischemic attack (TIA) are temporary and mild. Despite the transient nature of the focal symptoms and the absence of visible brain lesions in some patients, many experience persistent cognitive problems subsequently. We aimed to establish the discriminant capacity of the Montreal Cognitive Assessment (MoCA) in screening for cognitive impairment (CI) within 90 days of TIA. MethodA total of 50 patients with minor stroke or TIA were recruited. Patients were administered the MoCA test and a formal neuropsychological test battery. CI was defined clinically according to neuropsychological test findings. ResultsThe average age of recruited patients was 57.7±8.0 years; 70.0% were men; all patients had completed at least primary education. Thirty-seven patients (74.0%) presented CI. Receiver operating characteristic curve analysis obtained an optimal MoCA cut-off point of 25 for discriminating between patients with CI and those without, with an area under the curve of 0.835 (95% confidence interval [95% CI] 0.720-0.949), sensitivity of 78.4% (95% CI 62.8-88.6%), specificity of 76.9% (95% CI 49.7-91.8%), positive predictive value of 90.6% (95% CI 81.0-95.6%), and negative predictive value of 55.6% (95% CI 39.5-70.4%). ConclusionsMore than half of the patients presented CI as determined by the formal battery of neuropsychological tests. A MoCA cut-off point of 25 is sufficiently sensitive and specific for detecting CI after minor stroke or TIA, and may be implemented as a screening technique in routine clinical practice.

Samuel Laird Galbraith

<h3>Background:</h3> The ABCD² score predicts stroke risk within a few days of transient ischaemic attack (TIA). It is not clear whether the predictive value of the ABCD² score can be...

Trends over time in the risk of stroke after an incident transient ischemic attack.

Long-term population trends in the early risk of stroke after transient ischemic attack (TIA) are unknown. We hypothesized that there has been an appreciable decline in the risk of stroke after TIA for the last decade. Population-level cohort study from Victoria, Australia (population 5.6 million), using linked data from hospitals, emergency departments, and death records (2001-2011), with a 2-year clearance period to define incident TIAs. Age-specific rates/1000, yearly incident rate ratios, and age-sex-adjusted risk of stroke after TIA were computed. The mean age of 46 971 patients with TIA was 71 (SD=15), 52% women. In patients ≥65 years, annual TIA rates declined between 2001 and 2011 from 5.8 to 4.8/1000 (men) and from 5.3 to 4.2/1000 (women). Yearly incident rate ratios were 0.97 (95% confidence interval, 0.96-0.98) in men and 0.97 (95% confidence interval, 0.97-0.98) in women. Overall, the 90-day stroke risk was 3.1%. Age-sex-adjusted risk of stroke at 90 days after a TIA decreased by 3% per year (odds ratio for the effect of year, 0.97; 95% confidence interval, 0.95-0.99). Male sex, direct discharge from emergency departments, public hospital care, stroke unit care, and absence of vascular risk factors were associated with a downward yearly trend of stroke within 90 days of TIA. Over the last 10 years, there has been a measurable decline in the 90-day risk of stroke after an incident TIA and overall decline in rates of TIA in Victoria, Australia. These trends may reflect improved primary and secondary prevention efforts for the last decade.

Prognosis in patients with transient ischaemic attack (TIA) and minor stroke attending TIA services in the North West of England: The NORTHSTAR Study

Background:The ABCD2 score predicts stroke risk within a few days of transient ischaemic attack (TIA). It is not clear whether the predictive value of the ABCD2 score can be generalised...

Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis

Stroke is often preceded by transient ischaemic attack (TIA), but studies of stroke risk after TIA are logistically difficult and have yielded conflicting results. However, reliable estimation of this risk is necessary for planning effective service provision, clinical trials, and public education. We therefore did a systematic review of all studies of stroke risk early after TIA. All studies of stroke risk within 7 days of TIA were identified by use of electronic databases and by hand searches of reference lists, relevant journals, and conference abstracts. Stroke risks at 2 days and 7 days after TIA were calculated overall and analyses for heterogeneity were done, if possible, after categorisation by study method, setting, population, and treatment. 18 independent cohorts were included, which reported stroke risk in 10 126 TIA patients. The pooled stroke risk was 5.2% (95% CI 3.9-6.5) at 7 days, but there was substantial heterogeneity between studies (p<0.0001), with risks ranging from 0% to 12.8%. However, the risks reported in individual studies over different durations of follow-up were highly correlated (0-7 days vs 8-90 days, r=0.89, p<0.0001), and the heterogeneity between studies was almost fully explained by study method, setting, and treatment. The lowest risks were seen in studies of emergency treatment in specialist stroke services (0.9% [95% CI 0.0-1.9], four studies) and the highest risks in population-based studies without urgent treatment (11.0% [8.6-13.5], three studies). Results were similar for stroke risk at 2 days. The reported early risks of stroke after TIA were highly heterogeneous, but this could be largely accounted for by differences in study method, setting, and treatment, with lowest risks in studies of emergency treatment in specialist stroke services.

Validation and Refinement of Scores to Predict Very Early Stroke Risk after Transient Ischemic Attack: Johnston SC, Rothwell PM, Nguyen-Huynh MN, et al. LANCET 2007;369;283–92

This multi-institution study had three primary aims: 1) to validate the California and ABCD scores for prediction of stroke in patients who have suffered transient ischemic attack (TIA); 2) to generate a new scoring system that optimizes 2-day stroke risk prediction utilizing original data from the California and ABCD studies in combination with data from the present study; and 3) to validate this new scoring system in large cohorts. The authors state that 2-day stroke risk prediction is of high importance because half of all post-TIA strokes occurring within 90 days of TIA occur in the first 48 h.

Timing of stenting of symptomatic carotid stenosis is predictive of 30‐day outcome

For patients with symptomatic carotid stenosis, benefit from carotid artery stenting (CAS) highly depends on the 30-day stroke and death rates. Identification of predictors of unfavourable outcome would help guide the patient selection. We analysed the influence of clinical and angiographic factors on the 30-day outcomes of 77 consecutive patients who underwent CAS for > or = 60% symptomatic carotid stenosis within 180 days of transient ischaemic attack or moderate stroke (modified Rankin Scale score < or = 3). The 30-day composite end-point for stroke (7.8%) and death of any cause (1.3%) was 9.1%. Patients with complicated CAS were older than patients with uncomplicated CAS (mean age 75.1 +/- 8.2 vs. 65.9 +/- 9.5 years, P = 0.015) and underwent stenting significantly earlier after the qualifying event: median delay 1.5 weeks (range: 0.2-3.0) vs. 3.2 weeks (range: 0.5-26), P = 0.004. In multivariate logistic regression analyses, age [odds ratio (OR) = 1.148; 95% confidence interval (CI): 1.011-1.304 and P = 0.033] and delay of treatment < 2 weeks (OR = 22.399; 95% CI: 2.245-223.445 and P = 0.008) remained the only variables significantly associated with 30-day outcome. CAS carries a considerable risk in old patients and when performed early (< 2 weeks) after the qualifying event. Future reports should address the timing of CAS.

30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial

Carotid endarterectomy is effective in stroke prevention for patients with severe symptomatic carotid-artery stenosis, and carotid-artery stenting has been widely used as alternative treatment. Since equivalence or superiority has not been convincingly shown for either treatment, we aimed to compare the two. 1200 patients with symptomatic carotid-artery stenosis were randomly assigned within 180 days of transient ischaemic attack or moderate stroke (modified Rankin scale score of < or =3) carotid-artery stenting (n=605) or carotid endarterectomy (n=595). The primary endpoint of this hospital-based study was ipsilateral ischaemic stroke or death from time of randomisation to 30 days after the procedure. The non-inferiority margin was defined as less than 2.5% on the basis of an expected event rate of 5%. Analyses were on an intention-to-treat basis. This trial is registered at Current Controlled Trials with the international standard randomised controlled trial number ISRCTN57874028. 1183 patients were included in the analysis. The rate of death or ipsilateral ischaemic stroke from randomisation to 30 days after the procedure was 6.84% with carotid-artery stenting and 6.34% with carotid endarterectomy (absolute difference 0.51%, 90% CI -1.89% to 2.91%). The one-sided p value for non-inferiority is 0.09. SPACE failed to prove non-inferiority of carotid-artery stenting compared with carotid endarterectomy for the periprocedural complication rate. The results of this trial do not justify the widespread use in the short-term of carotid-artery stenting for treatment of carotid-artery stenoses. Results at 6-24 months are awaited.

Guidelines for the Early Management of Patients With Ischemic Stroke

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