Occurrence Of Transient Ischemic Attack Research Articles

Low Incidence of Neurological Adverse Events Among Pediatric Patients With Moyamoya Undergoing General Anesthesia for NonRevascularization Procedures

BackgroundGeneral anesthesia poses a significant risk for patients with MMA, yet its risk in the setting of nonrevascularization procedures remains unclear. Data regarding the risk of general anesthesia for nonrevascularization procedures are scarce. We therefore aimed to assess the incidence of neurological adverse events (NAEs) among pediatric patients with MMA undergoing general anesthesia for nonrevascularization procedures. MethodsWe conducted a retrospective cohort study at a tertiary referral pediatric center of patients with MMA aged ≤18 years, who underwent general anesthesia for nonrevascularization procedures between January 2014 and July 2023. Postanesthesia NAEs were defined as occurrence of transient ischemic attacks, seizures, altered mental status, severe headache, or evidence of arterial ischemic stroke (AIS) in the 30 days postprocedure. ResultsAmong 149 procedures on 38 patients (median age [interquartile range]: 8.3 [5.0, 12.7] years; 57% female), 124 (83.2%) procedures were imaging studies and angiographies and 25 (16.8%) were surgical procedures. Preprocedural hyperhydration treatment was administered before most (111, 74.5%) procedures per our institutional protocol. The incidence of postanesthesia NAEs was 0.67% (one of 149), as a result of acute AIS following a ventriculoperitoneal shunt revision surgery, in a patient with postradiation MMA, panhypopituitarism, and uncontrolled diabetes insipidus, despite preprocedural hyperhydration treatment. There were no NAEs after imaging studies performed under general anesthesia. ConclusionsOur results suggest that general anesthesia for nonrevascularization procedures in pediatric patients with MMA prepared with hyperhydration is safe. As neuroradiological follow-up is central in children with MMA, this information can be valuable for reassuring patients and their families.

Physical activity modification following a Transient Ischemic Attack in individuals with diabetes

BackgroundIndividuals with diabetes exhibit a higher risk of cardiovascular disease and mortality compared to healthy individuals. Following a transient ischemic attack (TIA) the risk of stroke and death increase further. Physical activity engagement after a TIA is an effective way of secondary prevention. However, there's a lack of research on how individuals with diabetes modify physical activity levels and how these adjustments impact survival post-TIA. This study aimed to determine the extent to which individuals with diabetes alter their physical activity levels following a TIA and to assess the impact of these changes on mortality.MethodsThis was a nationwide longitudinal study, employing data from national registers in Sweden spanning from 01/01/2003 to 31/12/2019. Data were collected 2 years retro- and prospectively of TIA occurrence, in individuals with diabetes. Individuals were grouped based on decreasing, remaining, or increasing physical activity levels after the TIA. Cox proportional hazards models were fitted to evaluate the adjusted relationship between change in physical activity and all-cause, cardiovascular, and non-cardiovascular mortality.ResultsThe final study sample consisted of 4.219 individuals (mean age 72.9 years, 59.4% males). Among them, 35.8% decreased, 37.5% kept steady, and 26.8% increased their physical activity after the TIA. A subsequent stroke occurred in 6.7%, 6.4%, and 6.1% of individuals, while death occurred in 6.3%, 7.3%, and 3.7% of individuals, respectively. In adjusted analyses, participants who increased their physical activity had a 45% lower risk for all-cause mortality and a 68% lower risk for cardiovascular mortality, compared to those who decreased their physical activity.ConclusionsPositive change in physical activity following a ΤΙΑ was associated with a reduced risk of mortality. Increased engagement in physical activity should be promoted after TIA, thereby actively supporting individuals with diabetes in achieving improved health outcomes.

Sex as a Predictor of Outcomes for Symptomatic Carotid Stenosis: A Comparative Analysis between CAS and CEA.

Reporting gender-related outcomes for symptomatic carotid lesion revascularization after both endarterectomy (CEA) and carotid artery stenting (CAS) procedures in an unselected group of patients treated by Italian Vascular Specialists. A retrospective study was conducted on patients presenting with recently symptomatic carotid stenosis treated by CAS and by CEA. The primary endpoint was the 30 days any stroke occurrence rate; secondary endpoints were technical success, occurrence of transient ischemic attack (TIA), acute myocardial infarction (AMI) and death. Demographic, clinical and procedural data were all noted in order to identify the outcome's determining factor. A total of 265 patients (193 males and 72 females) were enrolled, and of these 134 (50.5%) underwent CEA and 131 CAS (49.5%). At 30 days, the overall new stroke rate was 3.4% (one fatal), and no TIA, AMI or deaths were observed. Among strokes, seven major and two minor strokes were reported, with six after CEA and three after CAS (p = 0.32; OR: 2; CI95%: 0.48-8.17). The timing of revascularization has been found to be slightly associated with new stroke occurrence: seven out nine strokes were observed in patients treated within 14 days from symptom onset (5.5% vs. 1.4%; p = 0.08, OR: 3.8, CI95%: 0.77-18.56). Lastly, female patients presented a significantly higher risk of post-operative stroke compared to male patients: 6.9% vs. 2.1% (p: 0.05; OR: 3.52; CI95%: 0.91-13.52). Our experience seems to suggest that both CEA and CAS provide safe and effective results in treating patients presenting with symptomatic carotid stenosis. Regardless of the type of revascularization, female sex is an independent risk factor for stroke recurrence after treatment.

Blood Pressure Fluctuation Pattern Associated with 90-Day Ischemic Stroke and Transient Ischemic Attack After Total Knee Arthroplasty-A Retrospective Study.

Blood pressure (BP) fluctuation has been demonstrated to be closely associated with stroke. However, at present, no attention is paid to the BP fluctuation following total knee arthroplasty (TKA). The aim of this study is to investigate what is BP fluctuation patterns in stroke and transient ischemic attack (TIA) patients after primary TKA, compare clinical characteristics among different BP fluctuation patterns and determine whether it could predict the occurrence of a 90-day stroke. A retrospective study was conducted from February 1, 2011 to February 15, 2021. Stroke or TIA patients within 90 days after TKA were included. Data from a hospitalization management system were analyzed, including demographics, smoking status, comorbidities, medications, surgical variables, and 90-day stroke, mortality, and readmission rates. BP fluctuation patterns were defined based on the average BP in the first 3 days after TKA. A logistic regression analysis model was used to identify risk factors for 90-day stroke or TIA following TKA. Of the 1687 patients who underwent primary TKA, 4.0% (68/1687) experienced a 90-day stroke or TIA. A total of 63 patients met the inclusion criteria, with an average age of 67.5 years and 55.6% (35/63) female. The number of stroke or TIA patients in each BP fluctuation pattern (T1-T5) was 6 (9.5%), 5 (7.9%), 4 (6.3%), 13 (20.6%), and 35 (55.6%) respectively. Patients with a T5 pattern tended to be older and had a greater reduction in average systolic blood pressure (SBP) 3 days after surgery compared to other patterns. The T5 pattern was associated with a higher occurrence of stroke and a lower occurrence of TIA. Patients with a T5 pattern also had a longer length of stay within 90 days following TKA. After adjusting for confounding factors, average SBP fluctuation ≥40 mmHg and the T5 pattern of BP fluctuation remained risk factors for 90-day stroke or TIA after TKA. BP fluctuation patterns in the early postoperative period are associated with 90-day stroke and TIA following primary TKA.

50-W vs 40-W During High-Power Short-Duration Ablation for Paroxysmal Atrial Fibrillation: A Multicenter Prospective Study

BackgroundHigh-power short-duration (HPSD) radiofrequency ablation of atrial fibrillation (AF) increases first-pass pulmonary vein isolation (PVI) and freedom from atrial arrhythmias while decreasing procedural time. However, the optimal power setting in terms of safety and efficacy has not been determined. ObjectivesThis study compared the procedural characteristics and clinical outcomes of 50-W vs 40-W during HPSD ablation of paroxysmal AF. MethodsPatients from the REAL-AF prospective multicenter registry (Real-World Experience of Catheter Ablation for Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation) undergoing HPSD ablation of paroxysmal AF, either using 50-W or 40-W, were included. The primary efficacy outcome was freedom from all-atrial arrhythmias. The primary safety outcome was the occurrence of any procedural complication at 12 months. Secondary outcomes included procedural characteristics, AF-related symptoms, and the occurrence of transient ischemic attack or stroke at 12 months. ResultsA total of 383 patients were included. Freedom from all-atrial arrhythmias at 12 months was 80.7% in the 50-W group and 77.3% in the 40-W group (Log-rank P = 0.387). The primary safety outcome occurred in 3.7% of patients in the 50-W group vs 2.8% in the 40-W group (P = 0.646). The 50-W group had a higher rate of first-pass PVI (82.3% vs 76.2%; P = 0.040) as well as shorter procedural (67 minutes [IQR: 54-87.5 minutes] vs 93 minutes [IQR: 80.5-111 minutes]; P < 0.001) and radiofrequency ablation times (15 minutes [IQR: 11.4-20 minutes] vs 27 minutes [IQR: 21.5-34.6 minutes]; P < 0.001) than the 40-W group. ConclusionsThere was no significant difference in freedom from all-atrial arrhythmias or procedural safety outcomes between 50-W and 40-W during HPSD ablation of paroxysmal AF. The use of 50-W was associated with a higher rate of first-pass PVI as well as shorter procedural times.

Treating transient ischemic attack from the evil of Phlegm and blood stasis based on abnormal lipid metabolism

Transient ischemic attack (TIA) belongs to the category of cerebrovascular disease stroke, is a subtype of ischemic cerebrovascular disease, stroke incidence is very high, and is also an important cause of population death. The occurrence of TIA has a great relationship with vascular abnormalities, the formation of vascular plaque makes the blood vessels hardening and narrowing, and then leads to the occurrence of transient cerebral ischemia.Modern studies have found that the abnormal lipid metabolism is closely related to the occurrence of TIA. Traditional Chinese medicine treats TIA from the "evil gas of phlegm and blood stasis". In combination, the "evil gas of phlegm and blood stasis" is related to the abnormal lipid metabolism, which also confirms that the drugs for reducing phlegm and blood stasis and turbidity can inhibit the metabolic factors of TIA and play a role in preventing and preventing the disease before it is diagnosed.Western medicine's targeted regulation of abnormal lipid metabolism and Chinese medicine's lipid-regulating and pulse-softening therapy may have certain modern research significance.

Patch angioplasty during carotid endarterectomy using different materials has similar clinical outcomes

ObjectivePatch angioplasty during carotid endarterectomy (CEA) is commonly used to treat carotid artery stenosis. However, the choice of which patch to use remains a matter of debate. Autologous venous material has disadvantages such as wound-related problems at the harvest site and a prolonged intervention time. These limitations can be bypassed when synthetic or biological patches are used. Both materials have been associated with divergent advantages and disadvantages. Therefore, the aim of our study was to compare the long-term follow-up outcomes in patients who underwent CEA and closure with either a bovine pericardial patch (BPP) or polyester patch. MethodsA retrospective cohort study was conducted including all patients who underwent primary CEA and closure with a BPP or a polyester patch between January 2010 and December 2020 at our tertiary referral center. In 2015, the BPP was introduced as an alternative for polyester. The primary outcome was the occurrence of transient ischemic attack (TIA) or cerebrovascular accident (CVA) during follow-up and secondary outcomes included restenosis, reintervention, all-cause mortality, and patch infection. Cox proportional hazard models were used and hazard ratios with 95% confidence intervals were used to predict these outcomes. ResultsWe included 417 CEA patients; 254 patients (61%) received a BPP and 163 received (39%) a polyester patch. The mean age was 70.2 ± 8.7 years and 67% were male. The median follow-up time was 15 months (range, 12-27 months) for BPP and 42 months (range, 16-60 months) for polyester (P < .001). Postoperative hematoma (≤30 days) was significantly lower in the BPP cohort (2% BPP vs 6% polyester; P = .047). No other significant differences on short-term outcomes were found. Univariable Cox regression analyses showed no significant differences between the effect estimates of polyester and BPP on TIA or CVA (P = .106), restenosis (P = .211), reintervention (P = .549), or all-cause mortality (P = .158). No significant differences were found after adjusting for confounders in the multivariable analyses: TIA or CVA (P = .939), restenosis (P = .057), reintervention (P = .193) and all-cause mortality (P = .742). Three patients with a polyester patch had patch infection compared with none of the patients in the group who received a BPP. ConclusionsThis large retrospective study showed comparable safety and durability of both BPP and polyester suggesting that both patch types can be safely applied for CEA with patch angioplasty. Patch infection was rare and was absent in the BPP group.

Peri-procedural variables and outcomes of long-period hemodynamic instability after carotid artery angioplasty and stenting.

The aim of this study is to identify the peri-procedural risk factors and outcomes of hemodynamic instability (HI) after carotid artery stenting (CAS). A single-center, retrospective study was performed in 168 patients who underwent CAS procedure between September 2017 and September 2020. The presence of HI, as defined by hypertension (systolic blood pressure >160mmHg), hypotension (systolic blood pressure <90mmHg), and/or bradycardia (heart rate <60bpm), was recorded. Long-period HI was defined as persistent HI lasting more than 24h. Patient demographics, comorbidities, peri-procedural variables, and risk factors were recorded. Clinical outcomes including cerebral hyperperfusion syndrome, hemorrhage, transient ischemic attack (TIA), stroke, myocardial infarction, and mortality within 30days of the procedure were evaluated. Logistic regression was used to analyze the independent risk factors of long-period HI following CAS. Among 168 patients (mean age, 68.2 ± 8.3years; 81.5% male), the frequency of post-procedural long-period HI was noted in 42 patients (25.0%). Male was prone to experience HI (odds ratio, 9.156, p = 0.021). Aggressive inflation pressure (>7atm) and 5mm balloon for pre-dilatation were risk factors of long-period HI (OR, 7.372, p = 0.035; OR, 3.527, p = 0.023). Intraoperative peak blood pressure and larger-sized stents remained independent predictors for the development of HI (OR, 1.043, p = 0.027, and OR, 1.973, p = 0.015). Patients with prolonged HI were more likely to suffer TIA and stroke compared to other patients and significant difference was found in the occurrence of TIA (p < 0.05). Non-significance was found in mortality rate and other outcomes. CAS-induced HI occurs in a considerable percentage while several peri-procedural variables are determined as independent predictors to develop long-period HI. Patients with prolonged HI are associated with increased risk of neurologic events and thus standardized intervention as well as management of long-period HI are of critical importance during clinical process.

The Importance of Understanding the Risk Factors for TIA

Transient ischemic attack (TIA) and minor ischemic stroke are associated with brain dysfunction in a circumscribed area caused by a regional reduction in blood flow (i.e., ischemia), resulting in transient or minor observable clinical symptoms. We reported a case study of a female patient with a TIA with symptoms of dizziness, weakness of the left limb, and tingling for about 30 minutes. She was admitted to the emergency room and underwent several tests, including ECG, CT scan, and laboratory test to confirm the diagnosis. The patient probability of stroke infarct was determined by the ABCD2 score. Through ABCD2 score, the patient had 4.1% probability of Ischemic stroke without looking at the imaging features on a CT scan or MRI. By knowing the risk factors of TIA, the patient was suggested to modify lifestyle to prevent the occurrence of TIA due to TIA can be an early sign of ischemic stroke. Keywords: TIA, risk factors of TIA, TIA’s risk stratification.

Ефективність противірусної терапії у вторинній профілактиці ішемічного інсульту на тлі маніфестації вірусної інфекції

Recurrent stroke remains the key health issue in the world. A higher three-year recurrence rate of stroke in patients with persistence of the genome of herpes viruses, and with presence in the blood of the genome of at least 2 types of viruses was identified. These investigations demonstrate the importance of further research into the role of antiviral therapy in improving the rehabilitation and secondary prevention of stroke in patients with persistent viral infection The purpose of the study was to evaluate the effectiveness of antiviral therapy in the secondary ischemic stroke prevention on the viral infection manifestation background. Material and methods. The study included 105 patients with moderate to severe ischemic stroke with a viral manifestation confirmed by the detection of herpes virus’s DNA (HSV1, HSV2, EBV, CMV, HHV6) and Flu RNA. Patients who were additionally prescribed antiviral drugs on the background of traditional therapy were in the main group (n = 35). Patients who received only traditional, recommended by the modern stroke treatment guidelines, therapy and secondary stroke prevention measures were included in the comparison group (n = 70). Results and discussion. We found that the effectiveness of the proposed preventive treatment depended on the viral load of the patient. In the presence of three or more types of viruses, the proposed therapy provided a significantly lower ischemic stroke recurrence rate, compared to the patients who did not receive antiviral therapy 11.1% vs. 49.8%, p = 0.042. Prevention of recurrent ischemic stroke, which should have started as soon as possible after the development of the first stroke or transient ischemic attack occurrence, F. Rincon and R. L. Sacco (2008) consider the most relevant in this group of patients. Herewith, as emphasized by D. G. Hackam and J. D. Spence (2007), comprehensive prevention has reduced the risk of recurrent ischemic stroke by almost 80%, thus preventing 4 out of 5 possible disorders. However, both native and world literature still has a lack of systematic data of the problem of antiviral therapy using in patients with acute disorders of cerebral circulation, although it has been proven that infectious and inflammatory complications are an important pathogenetic factor of its unfavorable and severe outcome. M. S. Elkind et al. (2016) consider that antiviral drugs such as acyclovir may play an appropriate role in the prevention of recurrent ischemic stroke in children if their causal relation is confirmed. Conclusion. The use of acyclovir in complex rehabilitation therapy and secondary stroke prevention in patients with viral infection manifestation provided an increase in the average score of Bartel index after 1 year, p = 0.017. In the case of antiviral therapy using in the complex prevention of recurrent vascular events in patients with viral infection manifestation, the three-year recurrence rate of stroke is lower (p = 0.042)

Neurological Manifestations of Patients Hospitalized with Coronavirus Disease 2019 in Babol, Iran

Background: The coronavirus disease 2019 (COVID-19) has been associated with a wide range of clinical symptoms. Objectives: The present study aims to investigate the neurological manifestations among patients hospitalized with COVID-19 in Rouhani Hospital in Babol. Methods: This is a descriptive cross-sectional survey conducted in March and April 2020 on patients admitted to Rouhani Hospital in Babol with COVID-19. A number of 230 medical records were selected randomly from a list. The data were collected using the demographic characteristics questionnaire and a checklist for the neurological symptoms. Results: Among the 230 patients with COVID-19 (mean [SD] age, 59.85 [16.22] years; 138 men [60%]), 127 (56%) patients had at least one neurologic symptom. The most common symptoms of the central nervous system disorder were headache (34%), dizziness (25%), and impaired consciousness (20%), and the most prevalent symptoms of the peripheral nervous system disorder were taste impairment (17%) and smell impairment (16%). The occurrence of transient ischemic attack (TIA) in women was significantly higher than in men (P = 0.02). Moreover, the incidence of dizziness, impaired consciousness, ataxia, cerebrovascular accident (CVA), anorexia, and smell impairment had a significant relationship with age (P &lt; 0.05). Conclusions: The neurological manifestations are prevalent and substantial among patients with COVID-19. Therefore, it is suggested that the healthcare workers take these symptoms seriously, especially in the outbreak of COVID-19, and take the pertinent preventive and protective measures.

Wall shear stress can improve prediction accuracy for transient ischemic attack.

BACKGROUNDEarly prediction of transient ischemic attack (TIA) has important clinical value. To date, systematic studies on clinical, biochemical, and imaging indicators related to carotid atherosclerosis have been carried out to predict the occurrence of TIA. However, their prediction accuracy is limited.AIMTo explore the role of combining wall shear stress (WSS) with conventional predictive indicators in improving the accuracy of TIA prediction.METHODSA total of 250 patients with atherosclerosis who underwent carotid ultrasonography at Naval Military Medical University Affiliated Gongli Hospital were recruited. Plaque location, plaque properties, stenosis rate, peak systolic velocity, and end diastolic velocity were measured and recorded. The WSS distribution map of the proximal and distal ends of the plaque shoulder was drawn using the shear stress quantitative analysis software, and the average values of WSS were recorded. The laboratory indicators of the subjects were recorded. The patients were followed for 4 years. Patients with TIA were included in a TIA group and the remaining patients were included in a control group. The clinical data, laboratory indicators, and ultrasound characteristics of the two groups were analyzed. Survival curves were plotted by the Kaplan-Meier method. Receiver operating characteristic curves were established to evaluate the accuracy of potential indicators in predicting TIA. Logistic regression model was used to establish combined prediction, and the accuracy of combined predictive indicators for TIA was explored.RESULTSThe intraclass correlation coefficients of the WSS between the proximal and distal ends of the plaque shoulder were 0.976 and 0.993, respectively, which indicated an excellent agreement. At the end of the follow-up, 30 patients suffered TIA (TIA group) and 204 patients did not (control group). Hypertension (P = 0.037), diabetes (P = 0.026), homocysteine (Hcy) (P = 0.022), fasting blood glucose (P = 0.034), plaque properties (P = 0.000), luminal stenosis rate (P = 0.000), and proximal end WSS (P = 0.000) were independent influencing factors for TIA during follow-up. The accuracy of each indicator for predicting TIA individually was not high (area under the curve [AUC] < 0.9). The accuracy of the combined indicator including WSS (AUC = 0.944) was significantly higher than that of the combined indicator without WSS (AUC = 0.856) in predicting TIA (z = 2.177, P = 0.030). The sensitivity and specificity of the combined indicator including WSS were 86.67% and 92.16%, respectively.CONCLUSIONWSS at plaque surface combined with hypertension, diabetes, Hcy, blood glucose, plaque properties, and stenosis rate can significantly improve the accuracy of predicting TIA.

Cerebrovascular adaptations to cocaine-induced transient ischemic attacks in the rodent brain.

Occurrence of transient ischemic attacks (TIA) and cerebral strokes is a recognized risk associated with cocaine abuse. Here, we use a rodent model along with optical imaging to study cocaine-induced TIA and the associated dynamic changes in cerebral blood flow velocity (CBFv) and cerebrovasculature. We show that chronic cocaine exposure in mice resulted in marked cortical hypoperfusion, in significant arterial and venous vasoconstriction, and in a sensitized vascular response to an acute cocaine injection. Starting after 10 days of exposure, an acute cocaine challenge to these mice resulted in a TIA, which presented as hemiparalysis and was associated with an abrupt exacerbation of CBFv. The severity of the TIA correlated with the decreases in cortical CBFv such that the greater the decreases in flow, the longer the TIA duration. The severity of TIA peaked around 17-22 days of cocaine exposure and decreased thereafter in parallel to a reorganization of CBFv from superficial to deep cortical layers, along with an increase in vessel density into these layers. Here, we document for the first time to our knowledge evidence of a TIA in an animal model of chronic cocaine exposure that was associated with profound decreases in CBFv, and we revealed that while the severity of the TIA initially increased with repeated exposures, it subsequently improved in parallel to an increase in the vessel density. This suggests that strategies to accelerate cerebrovascular recovery might be therapeutically beneficial in cocaine abusers.

Diagnostic Accuracy of Transient Ischemic Attack from Physician Claims.

Hospitalization data underestimate the occurrence of transient ischemic attack (TIA). As TIA is frequently diagnosed in primary care, methodologies for the accurate ascertainment of a TIA from physician claims data are required for surveillance and health systems planning in this population. The present study evaluated the diagnostic accuracy of multiple algorithms for TIA from a longitudinal population-based physician billing database. Population-based administrative data from the province of British Columbia were used to identify the base population (1992-2007; N=102,492). Using discharge records for hospital admissions for acute ischemic stroke with a recent (<90 days) TIA as the reference standard, we performed receiver-operating characteristic analyses to calculate sensitivity, specificity, positive and negative predictive values and overall accuracy, and to compare area under the curve for each physician billing algorithm. To evaluate the impact of different case definitions on population-based TIA burden, we also estimated the annual TIA occurrence associated with each algorithm. Physician billing algorithms showed low to moderate sensitivity, with the algorithm for two consecutive physician visits within 90 days showing the highest sensitivity at 37.7% (CI 95%=37.4-38.1). All algorithms demonstrated high specificity and moderate to high overall accuracy, resulting in low positive predictive values (≤5%), low discriminability (0.53-0.57) and high false positive rates (1 - specificity). Population-based estimates of TIA occurrence were comparable to prior studies and declined over time. Physician billing data have insufficient sensitivity to identify TIAs but may be used in combination with hospital discharge data to improve the accuracy of estimating the population-based occurrence of TIAs.

Comparison of stent versus medical therapy for symptomatic patients with intracranial atherosclerotic stenosis: A meta-analysis

PurposeTo compare the outcomes of intracranial stent implantation and medical therapy for treatment of severe intracranial stenosis. MethodsArticles were identified from Medline, Cochrane, EMBASE, and Google Scholar published up to August 25, 2016. Eligible studies reported stroke occurrence, transient ischemic attack (TIA), and event-free survival rates in patients who suffered recent TIA or stroke caused by stenosis of a major intracranial artery and treated with either medical therapy or stenting. 4 studies enrolled a total 739 patients. ResultsWhile no association between intracranial endovascular therapy and short-term stroke risk was found (pooled OR=1.349, 95% CI=0.541 to 3.367, P=0.521), significantly higher rate of stroke occurrence was observed in patients treated with stent therapy within 30days of treatment (pooled OR=3.143, 95% CI=1.755 to 5.628, P<0.001). No association was found between the type of treatment and TIA occurrence (pooled OR=0.702, 95% CI=0.277 to 1.781, P=0.457) and event-free survival rate (pooled HR=1.170, 95% CI=0.947 to 1.447, P=0.145). ConclusionPatients with symptomatic intracranial atherosclerotic stenosis undergoing stent therapy may have higher risk of short-term stroke.

Transient Ischemic Attacks Preceding Acute Lacunar Infarction

Background: It has been reported that some patients with lacunar infarction have transient ischemic attacks (TIAs) before stroke. This study was aimed at evaluating the factors and prognostic value related to TIAs preceding acute lacunar stroke. Methods: A total of 1,424 patients were admitted to the hospital for first-ever ischemic stroke. Of which 314 patients with acute lacunar infarction were enrolled for this study. The patients were divided into 2 groups based on the occurrence of TIAs before stroke. Results: Fifty-eight patients (18.5%) had a history of preceding TIAs. The interval between TIA and stroke was less than 24 h in most patients (87.9%). Diabetes mellitus was more often found in patients with TIAs than in those without TIAs (48.3 vs. 28.9%, p = 0.004). Initial National Institute of Health Stroke Scale scores showed no significant difference between the 2 groups (median 2 vs. 3, p = 0.067). However, patients with preceding TIAs had a more favorable outcome (modified Rankin scale 0-1) than those without TIA at 3 months after stroke (79.6 vs. 63.2%, p = 0.021). Conclusion: Lacunar TIA may occur due to small perforating microatheromatous arteries caused by diabetes. This study suggests that ischemic tolerance may play a role in patients with preceding TIAs before lacunar infarct, allowing better recovery from a subsequent ischemic stroke.

Association of Rs2071410 on Furin with Transient Ischemic Attack Susceptibility and Prognosis in a Chinese Population.

BackgroundBecause genotype CG/GG of Furin rs2071410 can increase susceptibility to hypertension, this study investigated whether Furin rs2071410 is correlated with transient ischemic attack (TIA) susceptibility and prognosis.Material/MethodsThe odds ratios (ORs) and their 95% confidence intervals (95% CIs) were evaluated to assess the association of rs2071410 with TIA risk, and logistic regression was used to estimate the effects of various risk factors (e.g., diabetes, hypertension, and hyperlipidemia) on TIA.ResultsCompared with the homozygous genotype CC of rs2071410, the frequency of CG + GG genotype in the case group was significantly higher than in the control group (OR=1.47, 95% CI: 1.05–2.05, P<0.05). The CG + GG genotype carriers were observed to have worse 90-day prognosis after TIA treatment than patients carrying CC genotype (OR=12.86, 95% CI: 7.41–22.33, P<0.05). Moreover, logistic regression analysis found that age, diabetes, hypertension, and hyperlipidemia were associated with the onset of TIA (P<0.05, all). Of note, individuals with CG + GG genotype had 49.3% increased risk of TIA compared with individuals with CC genotype (OR=1.49, 95% CI: 1.05–2.12), and patients with CG + GG genotype had worse 90-day prognosis after TIA treatment than patients with CC genotype (OR=11.39, 95% CI: 6.29–20.62).ConclusionsFurin rs2071410 was significantly correlated with TIA occurrence and prognosis in the Chinese population.

The Influence of the Metabolic Syndrome on the Short- and Long-Term Outcome After Carotid Endarterectomy.

The metabolic syndrome (MetS) is a cluster of risk factors for cardiovascular disease. The aim of this study is to determine the influence of MetS on short- and long-term outcome and survival after carotid endarterectomy (CEA). Between January 2005 and December 2014, data from all patients undergoing CEA were prospectively recorded. The metabolic syndrome was defined based on the presence of ≥3 of the following criteria: hypertension, high serum triglycerides, low levels of high-density lipoprotein cholesterol, high fasting serum glucose, and obesity. Primary end points were the occurrence of transient ischemic attack (TIA)/cerebrovascular accident (CVA), myocardial infarction, and mortality. A total of 564 interventions (in 525 patients) were performed, of which 244 (43.3%) were in patients who met the diagnosis of MetS. There were no differences in short- and long-term complications and overall survival between patients with and without MetS. Patients with diabetes mellitus (DM) had significantly more ipsilateral TIA/CVA after 30 days ( P = .001). The presence of MetS has no negative effect on the outcome after CEA. However, patients with DM have a significantly higher risk of ipsilateral TIA/CVA.

Location of Cerebral Microbleeds May Predict Subsequent Stroke after Transient Ischemic Attack

Location of Cerebral Microbleeds May Predict Subsequent Stroke after Transient Ischemic Attack

Effects of Sarpogrelate Combined with Aspirin in Patients Undergoing Carotid Endarterectomy in China: A Single-Center Retrospective Study

Patients undergoing carotid artery stenosis who are prescribed aspirin, clopidogrel, or sarpogrelate as treatment options to inhibit platelet aggregation continues to increase. The purpose of this study was to compare the efficacy and safety of clopidogrel combined with aspirin (CA) versus sarpogrelate combined with aspirin (SA) treatment in carotid endarterectomy (CEA) patients. This retrospective study included 197 CEA patients (mean age 61.4years, mean follow-up time 42.5months), who were divided into a CA group (Group A: 65 male and 44 female patients) and an SA group (Group B: 58 male and 30 female patients). Preoperative demographic and clinical characteristics and postoperative results were compared between the 2 groups and statistically analyzed. Preoperative demographic and clinical characteristics, transfusions, hospital stay, occurrence of transient ischemic attack, stroke, myocardial infarction, restenosis, general or life-threatening bleeding, and 30-day mortality showed no significant differences between the 2 CEA patient groups. However, the mean operative blood loss (P=0.023) and the operative time (P=0.040) were significantly higher in Group A compared with Group B. Ahighly significant incidence of neck hematoma (P=0.024) was observed in patients of Group A. In this study on CEA patients, antiplatelet treatment with CA resulted in a significant risk of developing neck hematoma, increased operative blood loss, and operative time compared with SA treatment. Long-term prospective studies with larger study populations are needed to further confirm the utility of SA treatment for CEA patients.