Incidence Of Transient Ischemic Attack Research Articles

Epidemiology and management of transient ischemic attack in Trieste district, how day hospital assessment improves outcomes: a five-year retrospective study.

Transient ischemic attack (TIA) is defined as a transient episode of neurologic dysfunction, without acute infarction or tissue injury lasting less than 24h. Previous data suggest TIA precedes 15% of ischemic strokes, with a higher risk in the first week. Current practice guidelines advise evaluation through rapid neurological visit or admission to hospital. We provide data on TIA incidence in Trieste, and we compare three different types of assessment: day hospital (DH), stroke unit (SU), and emergency department/outpatients (ED). This is a 5-year retrospective study of transient cerebrovascular events admitted in the University Hospital of Trieste (230.623 inhabitants), between 2016 and 2020. We calculated TIA prevalence in Trieste district's general population. Our primary endpoint is ischemic recurrences within 90days, and we evaluate the possible association between different types of management. TIA incidence rate was 0.54/1000 inhabitants. In the multivariate analysis remained significantly associated with primary endpoint: ABCD2 (OR 1.625, CI 95% 1.114-2.369, p = 0.012) and DH evaluation (OR 0.260, CI 95% 0.082-0.819, p = 0.021). Incidence of TIA in Trieste district is in line with previous data. We demonstrate the crucial role of DH evaluation over the outpatient/ED in reducing overall mortality and recurrence rate. Prompt recognition of patients at high risk for cerebrovascular events and specialist follow-up may reduce the incidence of major vascular events and death.

Clopidogrel with indobufen or aspirin in minor ischemic stroke or high-risk transient ischemic attack: a randomized controlled clinical study

BackgroundIschemic stroke and transient ischemic attack (TIA) are the most prevalent cerebrovascular diseases. The conventional antiplatelet drugs are associated with an inherent bleeding risk, while indobufen is a new antiplatelet drug and has the similar mechanism of antiplatelet aggregation as aspirin with more safety profile. However, there have been no studies evaluating the combination therapy of indobufen and clopidogrel for antiplatelet therapy in cerebrovascular diseases.ObjectiveThe CARMIA study aims to investigate the effectiveness and safety of a new dual antiplatelet therapy consisting of indobufen and clopidogrel comparing with the conventional dual antiplatelet therapy consisting of aspirin and clopidogrel in patients with minor ischemic stroke or high-risk TIA.MethodsAn open-label randomized controlled clinical trial was conducted at a clinical center. We randomly assigned patients who had experienced a minor stroke or transient ischemic attack (TIA) within 72 h of onset, or within 1 month if they had intracranial stenosis (IS), to receive either indobufen 100 mg twice daily or aspirin 100 mg once daily for 21 days. For patients with IS, the treatment duration was extended to 3 months. All patients received a loading dose of 300 mg clopidogrel orally on the first day, followed by 75 mg once daily from the second day to 1 year. We collected prospective data using paper-based case report forms, and followed up on enrolled patients was conducted to assess the incidence of recurrent ischemic stroke or TIA, mRS score, NIHSS (National Institutes of Health Stroke Scale) score, and any bleeding events occurring within 3 month after onset.ResultsWe enrolled 202 patients diagnosed with ischemic stroke or transient ischemic attack. After applying the criteria, 182 patients were eligible for data analysis. Endpoint events (recurrence of ischemic stroke/TIA, myocardial infarction, or death) were observed in 6 patients (6.5%) receiving aspirin and clopidogrel, including 4 (4.3%) with stroke recurrence, 1 (1.1%) with TIA recurrence, and 1 (1%) with death. In contrast, no endpoint events were reported in the indobufen and clopidogrel group (P = 0.029). The group of patients receiving indobufen and clopidogrel exhibited significantly lower modified Rankin Scale (mRS) score. (scores range from 0 to 6, with higher scores indicating more severe disability) compared to the aspirin and clopidogrel group (common odds ratio 3.629, 95% CI 1.874–7.036, P < 0.0001). Although the improvement rate of NIHSS score in the indobufen and clopidogrel group was higher than that in the aspirin and clopidogrel group, the difference was not statistically significant (P > 0.05). Bleeding events were observed in 8 patients (8.6%) receiving aspirin and clopidogrel, including 4 (4.3%) with skin bleeding, 2 (2.2%) with gingival bleeding, 1 (1.1%) with gastrointestinal bleeding, and 1 (1.1%) with urinary system bleeding. On the other hand, only 1 patient (1.1%) in the indobufen and clopidogrel group experienced skin bleeding (P = 0.035).ConclusionThe combination of indobufen and clopidogrel has shown non-inferior and potentially superior effectiveness and safety compared to aspirin combined with clopidogrel in patients with minor ischemic stroke and high-risk TIA in the CARMIA study (registered under chictr.org.cn with registration number ChiCTR2100043087 in 01/02/2021).

Abstract TP231: Incidence of Stroke and Transient Ischemic Attack in Adults With Congenital Heart Disease: A Systematic Review and Meta-Analysis

Introduction: Congenital cardiac lesions result in abnormal flow patterns that increase risk of cerebrovascular events. We investigated the incidence of stroke and transient ischemic attack (TIA) in adults with congenital heart disease (ACHD). Methods: A systematic review was performed per PRISMA guidelines to identify all studies reporting the incidence of stroke and TIA in ACHD. Two independent reviewers screened studies, which were included if patients were age 16 and older with congenital heart disease, and if the outcome was stroke or TIA. Random-effects meta-analysis was conducted to estimate the pooled incidence rate of stroke and TIA with 95% confidence intervals. The Newcastle-Ottawa Scale for risk of bias was applied. This systematic review is registered (CRD42022322144). Results: Of 11,028 identified abstracts, 27 studies met inclusion criteria. 22 studies reported mean or median age, which was less than 60 years in 18 studies. 39 estimates of incidence rates from 24 studies were entered in the meta-analysis. The pooled incidence rate estimate of stroke and TIA was 0.58 per 100 person years, with significant heterogeneity between studies (95% CI 0.39-0.86, I2 97.8%, p&lt;0.001). Secondary analyses were performed stratified by CHD and outcome subtype. The pooled incidence rate of ischemic stroke was estimated at 0.59 per 100 person years (95% CI 0.36-0.95, I2 98%, p=0.01). Conclusions: This meta-analysis found that the incidence rate of stroke and TIA is higher in ACHD than age-adjusted global estimates, and similar to the American Heart Association reported global ischemic stroke incidence rate for individuals &gt;60 years (0.52 per 100 person years).

LAA occlusion is effective and safe in very high-risk atrial fibrillation patients with prior stroke: results from the multicentre German LAARGE registry.

Interventional left atrial appendage occlusion (LAAO) mitigates the risk of thromboembolic events in nonvalvular atrial fibrillation (AF) patientswith contraindication for long-term oral anticoagulation (OAC). Patients with prior stroke have a relevantly increased risk of recurrent stroke, so the effectiveness of LAAO could be reduced in this specific very high-risk patient group. This sub-study of the LAARGE registry investigates the effectiveness and safety of LAAO for secondary prevention in nonvalvularAF patients with a history of stroke. LAARGE is a prospective, non-randomised registry on the clinical reality of LAAO. The current sub-study employs data from index procedure and 1-year follow-up. Effectiveness and safety were assessed by documentation of all-cause mortality, non-fatal thromboembolism, procedure-related complications, and bleeding events. A total of 638 patients were consecutively included from 38 hospitals in Germany and divided into two groups: 137 patients with a history of stroke (21.5%) and 501 patients without. Successful implantation was consistent between both groups (98.5% vs. 97.4%, p = NS), while peri-procedural MACCE and other complications were rare (0% vs. 0.6% and 4.4% vs. 4.0%, respectively; each p = NS). Kaplan-Meier estimate showed no significant difference in primaryeffectiveness outcome measure (freedom from all-cause death or non-fatal stroke) between both groups at follow-up (87.8% vs. 87.7%, p = NS). The incidence of transient ischemic attack or systemic embolism at follow-up was low (0% vs. 0.5% and 0.9% vs. 0%, respectively; each p = NS). Severe bleeding events after hospitaldischarge were rare (0% vs. 0.7%, p = NS). Patients with prior stroke demonstrated similar effectiveness and safety profile for LAAO as compared to patients without prior stroke. LAAO could serve as a feasible alternative to OACfor secondary stroke prevention in this selected group of nonvalvular AF patients. NCT02230748.

Carotid endarterectomy compared with carotid artery stenting for extracranial carotid artery stenosis: a retrospective single-centre study

Aim: One of the main risk factors for an ischemic stroke is significant carotid artery stenosis, and extracranial severe carotid artery stenosis accounts for 20% of ischemic strokes. Prior to the development of carotid artery stenting (CAS), the only effective and reliable treatment for carotid artery stenosis was carotid endarterectomy (CEA). This study compares the results of CAS and CEA in patients with significant carotid artery stenosis. Methods: Between 2018 and 2022, hospital records of all patients who underwent carotid artery revascularization at the institution were retrospectively analyzed. Patients were divided into two groups depending on whether CEA or CAS was performed for carotid revascularization. Propensity score matching was performed to reduce bias by equating the baseline clinical characteristics of the groups. To compare 30-day, 1-year, and long-term outcomes, rates of transient ischemic attack (TIA), myocardial infarction, stroke, all-cause mortality, and composite endpoints were analyzed. Results: After PSM, 76 patients each in the CEA and CAS groups were compared. The mean age was 69.80 years ± 11.35 years and 121 (80%) were male. The patients were followed up for a mean of 33 months ± 6 months. The incidence of TIA in the perioperative period [9 (12%) vs. 4 (5%); P &lt; 0.05], TIA and composite endpoint at 1-year period [11 (15%) vs. 2 (3%); P &lt; 0.05 and 27 (36%) vs. 16 (21%); P &lt; 0.05, respectively] were significantly higher in the CAS group than in the CEA group. No difference was observed between the groups in the long-term. Conclusions: There was no noticeable difference between the CEA and CAS groups in the examination of cases with severe carotid artery stenosis in terms of 1-month, and 1-year results (apart from TIA and composite endpoints), or long-term outcomes. Extracranial carotid artery stenosis can be treated safely and effectively also by CAS.

Chronic Low Back Pain and Incident Transient Ischemic Attack and Stroke in General Practices in Germany.

The aim was to investigate the association between chronic low back pain (CLBP) and incident transient ischemic attack (TIA) and stroke in Germany. The present retrospective cohort study included adults aged ≥18 years who were diagnosed for the first time with CLBP in one of 1198 general practices in Germany in 2005-2019 (index date). Patients without CLBP were matched to those with CLBP (1:1) using a propensity score based on age, sex, the index year, the number of medical consultations per year during the follow-up, and the number of years of follow-up. In patients without CLBP, the index date was a randomly selected visit date. Both groups were followed for up to 10 years. There were 159,440 patients included in the study (mean (SD) age: 52.1 (16.5) years; 51.5% women). Within 10 years of the index date, 6.5% and 5.9% of patients with and without CLBP were diagnosed with TIA or stroke, respectively (log-rank p-value < 0.001). The Cox regression analysis corroborated these results, as there was a significant association between CLBP and incident TIA or stroke (HR = 1.28, 95% CI = 1.22-1.35). CLBP was positively and significantly associated with incident TIA and stroke in Germany. More research is warranted to better understand this relationship.

Prophylactic Levetiracetam for the Prevention of Seizures in Acute Nontraumatic Intracerebral Hemorrhage: A Retrospective Propensity-matched Patient Outcome Analysis (P7-5.030)

<h3>Objective:</h3> This study aims to determine if prophylactic levetiracetam in nontraumatic intracerebral hemorrhage (nt-ICH) decreases seizure risk and improves mortality. <h3>Background:</h3> Early seizures is a common morbidity in nt-ICH, often associated with worsening neurological outcome. There are conflicting data on the use of prophylactic antiepileptic drugs (AEDs) in the form of levetiracetam in this population. Current guidelines do not endorse prophylactic AED use due to limited evidence for clinical benefit; however, they are routinely prescribed in the acute setting. <h3>Design/Methods:</h3> This was a retrospective cohort study using data collected from TriNetX, a deidentified patient database collated from 71 healthcare organizations. Using ICD-10 codes, we identified nt-ICH patients excluding those with a history of seizure disorders. Patients were dichotomized based on prophylactic levetiracetam use or not. Propensity score adjustment matched cohorts on age, sex, race, significant comorbidities, complications of nt-ICH, location of nt-ICH, and NIHSS score. Associations with mortality; occurrence of seizure, acute kidney injury (AKI), transient ischemic attack (TIA), stroke, myocardial infarction; percutaneous endoscopic gastrostomy and tracheostomy placement at day 30 were measured between groups using unadjusted odds ratios (OR) with 95% confidence intervals (CI). <h3>Results:</h3> This study identified 1,571 patients with nt-ICH who received prophylactic levetiracetam and 9,570 patients who did not. After matching, 1,492 patients remained in each cohort. Our analysis showed that prophylactic levetiracetam in patients with nt-ICH was not associated with decreased seizure occurrence (OR, 1.21 [95% CI, 0.88, 1.68]) or mortality benefit (OR, 1.06 [95% CI, 0.90, 1.25]); was associated with decreased incidence of AKI (OR 0.552 [95% CI 0.344, 0.884]) and TIA [OR 0.496 (95% CI 0.304, 0.807)]. <h3>Conclusions:</h3> This data suggests that prophylactic levetiracetam does not provide a mortality benefit or decrease the occurrence of seizures in the acute setting of nt-ICH. Prospective studies are necessary to confirm these findings and assess the impact on longitudinal functional outcomes. <b>Disclosure:</b> Miss Nguyen has nothing to disclose. Ms. Bhanja has nothing to disclose. Dr. Hallan has nothing to disclose. Kevin Cockroft has received personal compensation in the range of $5,000-$9,999 for serving as an officer or member of the Board of Directors for Intersocietal Accreditation Commission. The institution of Kevin Cockroft has received research support from Intersocietal Accreditation Commission. The institution of Kevin Cockroft has received research support from Nico Corporation. The institution of Kevin Cockroft has received research support from Idorsia Pharmaceuticals . The institution of Kevin Cockroft has received research support from AstraZeneca . Dr. Rizk has nothing to disclose.

Effects of a Province-wide Triaging System for TIA: The ASPIRE Intervention.

Urgent transient ischemic attack (TIA) management to reduce stroke recurrence is challenging, particularly in rural and remote areas. In Alberta, Canada, despite an organized stroke system, data from 1999 to 2000 suggested that stroke recurrence after TIA was as high as 9.5% at 90 days. Our objective was to determine whether a multifaceted population-based intervention resulted in a reduction in recurrent stroke after TIA. In this quasi-experimental health services research intervention study, we implemented a TIA management algorithm across the entire province, centered around a 24-hour physician's TIA hotline and public and health provider education on TIA. From administrative databases, we linked emergency department discharge abstracts to hospital discharge abstracts to identify incident TIAs and recurrent strokes at 90 days across a single payer system with validation of recurrent stroke events. The primary outcome was recurrent stroke; with a secondary composite outcome of recurrent stroke, acute coronary syndrome, and all-cause death. We used an interrupted time series regression analysis of age-adjusted and sex-adjusted stroke recurrence rates after TIA, incorporating a 2-year preimplementation period (2007-2009), a 15-month implementation period, and a 2-year postimplementation period (2010-2012). Logistic regression was used to examine outcomes that did not fit the time series model. We assessed 6,715 patients preimplementation and 6,956 patients postimplementation. The 90-day stroke recurrence rate in the pre-Alberta Stroke Prevention in TIA and mild Strokes (ASPIRE) period was 4.5% compared with 5.3% during the post-ASPIRE period. There was neither a step change (estimate 0.38; p = 0.65) nor slope change (parameter estimate 0.30; p = 0.12) in recurrent stroke rates associated with the ASPIRE intervention implementation period. Adjusted all-cause mortality (odds ratio 0.71, 95% CI 0.56-0.89) was significantly lower after the ASPIRE intervention. The ASPIRE TIA triaging and management interventions did not further reduce stroke recurrence in the context of an organized stroke system. The apparent lower mortality postintervention may be related to improved surveillance after events identified as TIAs, but secular trends cannot be excluded. This study provides Class III evidence that a standardized population-wide algorithmic triage system for patients with TIA did not reduce recurrent stroke rate.

Stroke profile and care during the COVID-19 pandemic: What changed and what did not? A prospective cohort from Joinville, Brazil.

The COVID-19 pandemic has wrought negative consequences concerning quality of care for stroke patients since its onset. Prospective population-based data about stroke care in the pandemic are limited. This study aims to investigate the impact of COVID-19 pandemic on stroke profile and care in Joinville, Brazil. A prospective population-based cohort enrolled the first-ever cerebrovascular events in Joinville, Brazil, and a comparative analyzes was conducted between the first 12 months following COVID-19 restrictions (starting March 2020) and the 12 months just before. Patients with transient ischemic attack (TIA) or stroke had their profiles, incidences, subtypes, severity, access to reperfusion therapy, in-hospital stay, complementary investigation, and mortality compared. The profiles of TIA/stroke patients in both periods were similar, with no differences in gender, age, severity, or comorbidities. There was a reduction in incidence of TIA (32.8%; p = 0.003). In both periods, intravenous thrombolysis (IV) and mechanical thrombectomy (MT) rates and intervals from door to IV/MT were similar. Patients with cardioembolic stroke and atrial fibrillation had their in-hospital stay abbreviated. The etiologic investigation was similar before and during the pandemic, but there were increases in cranial tomographies (p = 0.02), transthoracic echocardiograms (p = 0.001), chest X-rays (p < 0.001) and transcranial Doppler ultrasounds (p < 0.001). The number of cranial magnetic resonance imaging decreased in the pandemic. In-hospital mortality did not change. The COVID-19 pandemic is associated with a reduction in TIA, without any influence on stroke profile, the quality of stroke care, in-hospital investigation or mortality. Our findings show an effective response by the local stroke care system and offer convincing evidence that interdisciplinary efforts are the ideal approach to avoiding the COVID-19 pandemic's negative effects, even with scarce resources.

Effects of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting on Clinical Outcomes in Patients with Reduced Ejection Fraction Heart Failure and Coronary Heart Disease: A Meta-Analysis.

To clarify the effects of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) on the clinical outcomes of patients with coronary heart disease (CHD) complicated with reduced ejection fraction heart failure (HFrEF) through meta-analysis. Three major literature databases - PubMed, Web of Science, and Cochrane - were searched by search terms and the literature retrieval time was publications dating from January 2007 to December 2021. To search for observational studies and randomized controlled trials (RCT) comparing the efficacy of PCI and CABG in patients with CHD and HFrEF, the abstract or full text of the literature was read and the final included literature was determined, according to inclusion and exclusion criteria. The quality of the included literature was evaluated using the Ottawa scale and data extraction was further completed. Data analysis was made using RevMan5.4 and R4.1 software; relevant forest plots and funnel plots were made, according to the extracted data. Egger's test was used to evaluate whether the data had publication bias. Outcomes were the major adverse cardiovascular events (MACE). A total of 10 studies were included and 11,032 subjects were included, made up of 5,521 cases of PCI and 5,511 cases of CABG. The results showed no significant difference between the two groups in cardiac mortality (CM) (RR=1.13, 95% CI 0.98-1.30, P = 0.10) and in overall all-cause mortality (ACM) (RR=1.12, 95% CI 0.92-1.37, P = 0.25). In the subgroup analysis of ACM, in the subgroups with left ventricular ejection fraction (LVEF) less than 35% and exceeding 35% and less than 50% (RR=1.12, 95% CI 0.92-1.37, P = 0.25) between the two groups, there was no statistical difference. However, among other MACE, compared with the PCI group, the CABG group had a lower risk of MACE (RR=1.58, 95%CI 1.49-1.70, P < 0.00001), myocardial infarction (MI) (RR=1.99, 95% CI 1.02-3.88, P = 0.04), heart failure (HF) (RR=1.29, 95% CI 1.17-1.43, P < 0.00001) and revascularization (RR=2.74, 95% CI 1.93-3.90, P < 0.00001). Finally in the CABG group, the risk of stroke or transient ischemic attack (TIA) was higher (RR=0.71, 95% CI 0.58-0.86, P = 0.0006) than the PCI group. The mortality rates of PCI and CABG were similar in patients with CHD complicated with HFrEF. Compared with PCI, CABG had a lower incidence of MACE, MI, HF, and revascularization, and a higher incidence of stroke or TIA.

Transient ischemic attack events and incident cardiovascular and non-cardiovascular complications: Observations from a large diversified multimorbid cohort.

Transient ischemic attack (TIA) is a strong signal prompting the incidence of future cardiovascular and non-cardiovascular complications, in light of recent debate on the so-called "stroke-heart syndrome." We aimed to investigate the relation of TIAs to incident clinical events. Patients were drawn from three health plans with a wide spectrum of age groups and a wide mix of socio-economic/disability status. Two TIA cohorts in a retrospective design were used to achieve the study specific aims: (i) to investigate the incidence of TIA and associated cardiovascular and non-cardiovascular complications within 30 and 90 days from the onset of incident TIA events; and (ii) to examine the potential risk factors for developing incident TIA events in the general population with/without a history of prior stroke. The incident TIA cohort consisted of 53,716 patients with an average age of 64.2 years (SD 15.2) and 46.1% male. Following TIA, the incidence proportions of ischemic stroke within 30 and 90 days were 2.7% and 3.8%, respectively, and for incident acute coronary syndrome being 0.94 and 1.84, respectively. Ventricular arrhythmia had proportions of 1.2 and 2.14, respectively within 30 and 90 days, with acute heart failure having values of 0.49 and 0.923. About 45% or more of the cardiovascular and non-cardiovascular complications occurred in the first 30 days following the incident TIA cases. About one-third of the recurrent TIA cases followed the incident TIA cases within a span of 30 days. Amongst comorbidities with stroke in the comorbid history, prior stroke provided the strongest risk factor in terms of odds ratio (OR = 8.34, 95% CI 7.21-9.66) for incident TIA events. Age was strongly associated with incident TIA events. Without a prior history of stroke (ischemic stroke/transient ischemic attack/thrombo-embolic events), valvular disease was the strongest risk factor from among the comorbidities (OR-1.87, 95% CI 1.51-2.32). Age also provided strong associations with incident TIA events. Following a TIA, there was a high risk of stroke, acute coronary syndrome, ventricular arrhythmia, acute heart failure, and non-cardiovascular complications.

Cost-effectiveness of carotid artery stenting vs endarterectomy: A simulation

ObjectiveClinical trials conducted before the introduction of modern medical management to prevent stroke demonstrated that carotid endarterectomy (CEA) and carotid artery stenting (CAS) prevent stroke following transient ischemic attack (TIA). We compared the cost-effectiveness of CEA, CAS, and modern medical management in two secular settings of medical management in individuals with incident TIA and type 2 diabetes. MethodsUsing simulation modeling, our base-case analyses were performed from the healthcare sector perspective over a 20-year time horizon with an annual 3% discount rate applied to both costs and quality-adjusted life years (QALYs). Outcomes depended on age, sex, biomarkers associated with cardiovascular risk, and treatment effects based on a validated model of type 2 diabetes. Our simulation population was drawn from the National Health and Nutrition Examination Survey (NHANES) 2014 cohort. Costs for modern medical management were based on average wholesale prices, and revascularization costs were derived from published literature. One-way and probabilistic sensitivity analyses were conducted. ResultsCompared to all other strategies, historical medical management plus CEA was either cost-saving or cost-effective at a threshold of $100,000 per QALY gained. Modern medical management was cost-effective compared to historical medical management without revascularization at a $100,000 acceptability threshold. However, both revascularization approaches (plus medical management) were cost-saving compared to modern medical management alone. ConclusionAmong individuals requiring carotid revascularization, carotid endarterectomy is the cost-effective strategy to treat individuals with type 2 diabetes following a TIA. For individuals for whom revascularization is contraindicated, modern medical therapy is cost-effective.

Clinical Progress and Prognosis in TIA: Experiences of a Specialised Neurology Hospital

Objective: The current development of acute stroke units led to an increase in morbidity of stroke patients while causing a decrease in overall mortality. Therefore, the cost of stroke care and treatment took a serious toll on national economies worldwide. Primary prevention of stroke should remain the main objective of primary healthcare. Following a transient ischemic attack (TIA), the patients have a 10-20% risk of developing an ischemic stroke. Our main objective in the present work was to summarize risk factors, imaging modalities, etiologic factors, and treatment modalities in TIA patients and to determine the rate of recurrence of TIA and ischemic stroke incidence in 1 year follow up in an academic medical center specialized in neurology. Method: 119 patients with TIA who received inpatient management in a 3-year period were included in this study. Patients were grouped by age, gender, distribution and duration of symptoms; recurrence, risk factors, and history of antiplatelet/anticoagulant use. A routine stroke protocol was followed for all patients. The patients were stratified by OCSP and TOAST criteria. The patients were re-evaluated at 3rd, 6th, and 12th months after discharge, and new stroke/TIA occurrence rate, risk factors and the presence of ischemic lesions on neuroimaging were recorded. Results: Of the patients who were included in this study, 52.9% was male, 42.1% was female. 87 of the patients (73.1%) had anterior circulation and 32 of the patients (26.9%) had posterior circulation pathologies. Recurrence of symptoms was observed in 60 patients (50.4%) after the first event. Diabetes, hyperlipidemia and hypertension were discovered to be the closest risk factors to be proven statistically significant. Posterior circulation TIA, and cardioembolic TIA ratios were more frequent when compared to the literature. During the one year follow up 8.4% of the patients reported experiencing new ischemic stroke or TIA, and only 2 patients died. Conclusion: Tight risk factor control and adherence to treatment protocols selected based on etiology are critical to decreasing ischemic stroke incidence following TIA.

Incidence of first-ever transient ischemic attack in Eastern Finland.

The incidence of stroke has been declining in Finland, as well as in Europe. However, it is unclear whether the incidence of transient ischemic attack (TIA) is also decreasing. In fact, the TIA incidence in the Finnish population has never been reported. Therefore, here we investigated the incidence of TIA in the Eastern Finnish population in 2017. All patients with suspected TIA, from a defined catchment area, were referred to a neurological emergency unit at Kuopio University Hospital (KUH) in the Northern Savonia region of Eastern Finland, which had a population of 246,653 in 2017. The original study population comprised TIA patients diagnosed based on the WHO TIA criteria in 2017. Incidence rates were calculated by dividing the number of TIA cases by the number of people in different age groups. Among 432 patients with a suspected TIA referred to the neurological emergency unit at Kuopio University Hospital in 2017, 293 were living in Northern Savonia and were ultimately diagnosed with TIA after neurological examinations. The number of first-ever TIAs was 211. The crude incidence of all TIA was 122/100,000 inhabitants, and of first-ever TIA was 86/100,000. The age-standardized incidence (European population 2010) of the first-ever TIA was calculated to be 64/100,000. The mean age of first-ever TIA patients was 70 years: 72 years for women versus 68 years for men. We found a high incidence of TIA in Eastern Finland.

Prevalence and its associated factors of extracranial carotid stenosis in patients with transient ischemic or ischemic stroke in Bach Mai Hospital

Incidence of transient ischemic attack (TIA) or ischemic stroke has increased in recent years in Viet Nam due to lifestyle changes. Carotid stenosis is a common cause of TIA/ischemic stroke. The purpose of this study was to estimate current prevalence and identify risk factors of ipsilateral internal carotid artery (ICA) stenosis in patients with TIA/ischemic stroke. We recruited patients hospitalized to Bach Mai hospital in the first half of 2021 who suffered from TIA/ischemic stroke. The primary outcome is the presence of significant carotid stenosis, defined as atherosclerotic narrowing of 50 percent or greater, and confirmed by multidisciplinary team (MDT) discussion. In total, 328 consecutive patients with TIA/ischemic stroke were included in this study. Of these, 29 (8.84%, 95% confidence interval (CI): 6.0 -12.45) have 50-99% ipsilateral ICA stenosis. Patients with considerable ICA stenosis are more likely to have type 2 diabetes, ischemic heart disease (IHD) and higher creatinine serum level. On multivariate logistic regression, type 2 diabetes (OR 2.61; CI 95%: 1.14 -5.97, p = 0,034), IHD (OR 5.27; CI 95%: 1.68 - 16.56, p &lt; 0.001), creatinine level (OR 1.15/10 mmol/l ; CI 95%: 1.01 -1.3, p = 0.031) are statistically significant risk factors for 50-99% ICA stenosis. The prevalence of extracranial ICA stenosis in TIA/ischemic stroke patient in Viet Nam is lower than Western countries but quite similar to Asia regions. Diabetes mellitus, IHD and high creatinine level are important risk factors for symptomatic ICA stenosis.

May 2022 Stroke Highlights

May 2022 <i>Stroke</i> Highlights

Vertebral artery stenosis predicts cerebrovascular diseases following radiotherapy for nasopharyngeal carcinoma.

Radiotherapy for nasopharyngeal carcinoma (NPC) may induce cerebrovascular diseases including ischemic stroke and transient ischemic attack (TIA), which can cause severe disability. However, information on the incidence and predictors of cerebrovascular diseases is scarce. This study aimed to estimate the incidence of cerebrovascular diseases following NPC, and attempts to ascertain the predictors of cerebrovascular diseases to facilitate early prevention. We performed a retrospective cohort study on 655 NPC patients who received radiotherapy between 2006 and 2018 in a medical center. This study analyzed the incidence, clinical and imaging presentation of patients with cerebrovascular diseases. Cox proportional hazard model was used to identify risk factors associated with cerebrovascular diseases following radiotherapy. There were 14 patients who developed an ischemic stroke, and 3 patients developed a TIA after a mean follow-up of 5.8years. Most ischemic events were from large-artery atherosclerosis (76.5%), and the most common symptom of ischemic stroke was unilateral limb weakness (57.1%). The cumulative incidence of ischemic stroke or TIA 15years after radiotherapy was 9.1% (95% confidence interval [CI] = 4.7-17.2%). Multivariate Cox regression identified vertebral artery stenosis (HR: 18.341; 95% CI = 3.907-86.100; P < 0.001), atrial fibrillation (HR: 13.314; 95% CI = 1.306-135.764; P = 0.029), and hypertension (HR: 7.511; 95% CI = 1.472-38.320; P = 0.015) as independent predictors of ischemic stroke or TIA. Our study found that NPC patients with vertebral artery stenosis, atrial fibrillation, or hypertension carry a higher risk for ischemic stroke or TIA. Regular assessment of vertebral artery after radiotherapy was suggested.

Tooth Loss and the Incidence of Ischemic Stroke and Transient Ischemic Attack: A Systematic Review and Meta-Analysis.

Generally, as the population is aging, ischemic stroke is imposing rising social and economic burdens. On that basis, the early intervention and prevention of ischemic stroke turns out to be a major public health issue. Extensive studies have reached mixed conclusions regarding the correlation between tooth loss and ischemic stroke, as well as transient ischemic attack (TIA). In this paper, a systematic review and meta-analysis is presented where we have aimed to examine whether tooth loss is correlated with a higher incidence of ischemic stroke and TIA in adults. The systematical search was conducted in PubMed, Web of Science, Embase, and The Cochrane library from the inception dates to September 23, 2021, by employing the keywords (i.e., tooth loss and ischemic stroke). Observational studies conducted in adults were included, in which people with and without tooth loss (Exposition and Comparison) were observed to determine the incidence of ischemic stroke/TIA (Outcome). The data were extracted, and the study quality was assessed by two reviewers independently. Moreover, a meta-analysis was conducted to obtain the risk ratios (RRs) and 95% CIs by adopting random-effects models. The major outcome was the incidence of ischemic stroke/TIA in adults with and without tooth loss. On the whole, four cohort studies and three case-control studies were covered, which involved 4,625,514 participants with 33,088 ischemic stroke/TIA cases. In cohort (adjusted RR = 2.58, 95% CI: 2.39–2.79, P < 0.00001, I2 = 31%) and case-control studies (adjusted MD = −4.15, 95% CI: −6.09−(−2.22), P < 0.001, I2 = 77%), a significant correlation was identified between tooth loss and ischemic stroke. The subgroup analyses reported that the results in case-control studies were generally consistent regardless of the selection of controls. This meta-analysis indicated a certain correlation between tooth loss and ischemic stroke.

Епідеміологія транзиторних ішемічних атак у структурі гострих порушень мозкового кровообігу в Україні та інших країнах

Актуальність. Медико-соціальне значення проблеми гострих порушеннь мозкового кровообігу визначається високою питомою вагою їх у структурі захворюваності та смертності населення, високими показниками первинної інвалідності. Мета дослідження. Вивчення та узагальнення статистичних даних щодо епідеміології транзиторних ішемічних атак у структурі гострих порушень мозкового кровообігу в Україні та інших країнах. Матеріали та методи. Аналітичний огляд наукових публікацій та офіційних статистичних звітів за останні 15 років із використанням сучасних наукометричних баз даних і фондів наукових бібліотек України, Європейського Союзу, Великобританії, Сполучених Штатів Америки. Висновки. Проведений епідеміологічний аналіз свідчить про підвищений інтерес клініцистів до проблеми гострих порушень мозкового кровообігу з епідеміологічних і організаційних питань, що сприятиме удосконаленню терапевтичних методів, зниженню захворюваності, поширеності, інвалідності та смертності населення, а також продовженню тривалості якісного життя таких пацієнтів.

Temporal Changes and Clinical Implications of Delayed Peridevice LeakFollowing Left Atrial AppendageClosure.

The aim of this study was to assess temporal changes and clinical implications of peridevice leak (PDL) after left atrial appendage closure. Endocardial left atrial appendage closure devices are alternatives to long-term oral anticoagulation (OAC) for patients with atrial fibrillation. PDL >5mm may prohibit discontinuation of OAC. Patients included in the study had: 1) successful Watchman device implantation without immediate PDL; 2) new PDL identified at 45 to 90days using transesophageal echocardiography; 3) eligibility for OAC; and 4) 1 follow-up transesophageal echocardiographic study for PDL surveillance. Relevant clinical and imaging data were collected by chart review. The combined primary outcome included failure to stop OAC after 45 to 90days, transient ischemic attack or stroke, device-related thrombi, and need for PDL closure. Relevant data were reviewed for 1,039 successful Watchman device implantations. One hundred eight patients (10.5%) met the inclusion criteria. The average PDL at 45 to 90days was 3.2 ± 1.6mm. On the basis of a median PDL of 3mm, patients were separated into≤3mm (n=73) and >3mm (n=35) groups. In the≤3mm group, PDL regressed significantly (2.2 ± 0.8mm vs 1.6 ± 1.4mm; P=0.002) after 275 ± 125days. In the >3mm group, there was no significant change in PDL (4.9 ± 1.4mm vs 4.0 ± 3.0mm; P=0.12) after 208 ± 137days. The primary outcome occurred more frequently (69% vs 34%; P=0.002) in the >3mm group. The incidence of transient ischemic attack or stroke in patients with PDL was significantly higher compared with patients without PDL, irrespective of PDL size. New PDL detected by transesophageal echocardiography at 45 to 90days occurred in a significant percentage of patients and was associated with worse clinical outcomes. PDL≤3mm tended to regress over time.