Onset Of Transient Ischemic Attack Research Articles

Proposed general diagnostic criteria for secondary headaches.

The distinction between a pre-existing primary headache and a secondary headache at the onset of a disorder is important and has not been taken into account in the International Classification of Headache Disorders-3. This study aimed to improve the general diagnostic criteria for secondary headaches using results of our previous studies. We analyzed characteristics of headaches including their changes in intensity, duration, frequency, localization and side, development of new accompanying symptoms, and therapeutic response at the onset of transient ischemic attacks (TIA) (n = 120, mean age 56.1, 55% females) and ischemic stroke (n = 550, mean age 63.1, 56% females) compared to the control group (n = 192, mean age 58.7, 64% females). Headache of a new type occurred in 8.4% of ischemic stroke patients and 5% of TIA patients on the day of admission but did not occur at all in the control group. Pre-existing headache with a change of at least one characteristic occurred significantly more often in stroke (5.4%) and TIA (7.5%) than in the control group (1%) (p = 0.01 and p = 0.003 respectively). The presence of a new type of headache and a pre-existing headache with altered characteristics in close temporal relation to a disorder indicates causality. Based on these data we propose revised general diagnostic criteria for secondary headaches.

Plasma metabolomic profiling of patients with transient ischemic attack reveals positive role of neutrophils in ischemic tolerance

Transient ischemic attack (TIA) induces ischemic tolerance that can reduce the subsequent ischemic damage and improve prognosis of patients with stroke. However, the underlying mechanisms remain elusive. Recent advances in plasma metabolomics analysis have made it a powerful tool to investigate human pathophysiological phenotypes and mechanisms of diseases. In this study, we aimed to identify the bioactive metabolites from the plasma of patients with TIA for determination of their prophylactic and therapeutic effects on protection against cerebral ischemic stroke, and the mechanism of TIA-induced ischemic tolerance against subsequent stroke. Metabolomic profiling using liquid chromatography-mass spectrometry was performed to identify the TIA-induced differential bioactive metabolites in the plasma samples of 20 patients at day 1 (time for basal metabolites) and day 7 (time for established chronic ischemic tolerance-associated metabolites) after onset of TIA. Mouse middle cerebral artery occlusion (MCAO)-induced stroke model was used to verify their prophylactic and therapeutic potentials. Transcriptomics changes in circulating neutrophils of patients with TIA were determined by RNA-sequencing. Multivariate statistics and integrative analysis of metabolomics and transcriptomics were performed to elucidate the potential mechanism of TIA-induced ischemic tolerance. Plasma metabolomics analysis identified five differentially upregulated metabolites associated with potentially TIA-induced ischemic tolerance, namely all-trans 13,14 dihydroretinol (atDR), 20-carboxyleukotriene B4, prostaglandin B2, cortisol and 9-KODE. They were associated with the metabolic pathways of retinol, arachidonic acid, and neuroactive ligand-receptor interaction. Prophylactic treatment of MCAO mice with these five metabolites significantly improved neurological functions. Additionally, post-stroke treatment with atDR or 9-KODE significantly reduced the cerebral infarct size and enhanced sensorimotor functions, demonstrating the therapeutic potential of these bioactive metabolites. Mechanistically, we found in patients with TIA that these metabolites were positively correlated with circulating neutrophil counts. Integrative analysis of plasma metabolomics and neutrophil transcriptomics further revealed that TIA-induced metabolites are significantly correlated with specific gene expression in circulating neutrophils which showed prominent enrichment in FoxO signaling pathway and upregulation of the anti-inflammatory cytokine IL-10. Finally, we demonstrated that the protective effect of atDR-pretreatment on MCAO mice was abolished when circulating neutrophils were depleted. TIA-induced potential ischemic tolerance is associated with upregulation of plasma bioactive metabolites which can protect against cerebral ischemic damage and improve neurological functions through a positive role of circulating neutrophils. National Natural Science Foundation of China (81974210), Science and Technology Planning Project of Guangdong Province, China (2020A0505100045), Natural Science Foundation of Guangdong Province (2019A1515010671), Science and Technology Program of Guangzhou, China (2023A03J0577), and Natural Science Foundation of Jiangxi, China（20224BAB216043).

Association between plasma trimethylamine-N-oxide and cognitive impairment in patients with transient ischemic attack

ABSTRACT Background There is increasing evidence for the association of trimethylamine-N-oxide (TMAO) with cognitive impairment after minor stroke or transient ischemic attack (TIA). However, how TMAO affects cognitive function in TIA patients has seldom been studied. Methods A total of 310 TIA participants were retrospectively collected from our stroke register between January 2020 and July 2021. Plasma TMAO was measured by liquid chromatography‒mass spectrometry at baseline. Cognitive performance was assessed by neuropsychological evaluation at 3 months after TIA onset. Results A total of 310 patients were included (mean age, 74 years; male, 160 [51.6%]; mean ABCD2 score, 2.6). TMAO was positively associated with cognitive impairment after TIA (aOR, 1.423; 95% CI, 1.125–2.561). The highest quartile of TMAO was related to an almost 2-fold increased risk of cognitive decline compared to the lowest quartile. Furthermore, executive and memory function were more susceptible to impairment after TIA in groups with higher levels of TMAO. Mediation analysis revealed that the overall mediated effect was−0.347 (p < 0.001), and the intermediary effect of CRP was−0.108. Conclusion Plasma TMAO at baseline was independently associated with cognitive impairment at the 3-month follow-up after TIA. In addition, the inflammatory marker CRP may serve as an important mediator in this relationship. Our study may provide some insights into anti-inflammatory therapy to improve the cognitive trajectory of TIA patients with high TMAO levels.

Antiplatelets in Acute Management and Prevention of Transient Ischemic Attack and Stroke

Abstract Introduction: Antiplatelet drugs (AD) reversibly or irreversibly inhibit activation and platelet aggregation and hence inhibit genesis of thrombus. Methods: In this article, we review the administration of AD in acute stroke management as well as in the primary and secondary prevention of stroke and transient ischemic attack (TIA). Conclusions: For primary stroke prevention of the first ever stroke, aspirin is advised only when a 10-year vascular risk is more than 10%, patient has a likely survival of &gt;10 years and has a low risk for hemorrhage. For patients with acute ischemic stroke (AIS) or TIA administration of aspirin is strongly recommended within 24–48 h of symptom onset. For patients managed with IV thrombolysis, aspirin administration should be deferred for 24 h. For patients with recent minor non cardioembolic AIS and a National Institutes of Health Stroke Scale (NIHSS) score ≤3 or patients with a high-risk TIA with ABCD2 score ≥4, dual Antiplatelet therapy with aspirin and clopidogrel should be started within 12–24 h of stroke or TIA onset and definitely within a week of onset and then should be continued for a period of 21–90 days, followed by switching to a single antiplatelet therapy. The US Food and Drug Administration has given approval for Ticagrelor usage to prevent the risk of for stroke recurrence in patients with AIS with a NIHSS score of ≤5 or high-risk TIA where ticagrelor – Aspirin combination maybe prescribed for 30 days. For patients who are carriers of CYP2C19 a 90-day ticagrelor – Aspirin offers better stroke prevention. ADs in dual combination for short term and single agent in the long term remain the dominant therapy for prevention of non-cardioembolic ischemic stroke.

LncRNA KCNQ1OT1 predicts further cerebral events in patients with transient ischemic attack.

Transient ischemic attack (TIA) poses a great threat of cerebrovascular diseases to a large number of patients, despite its reversible neurological dysfunction. Long non-coding RNAs (lncRNAs) have been proven to play critical roles in the pathophysiological development of cerebrovascular events. Exploring the function of lncRNAs in modulating TIA prognosis would help to develop individualized therapeutics. A total of 231 participants with the first onset of TIA were recruited in the study, including 65 subsequent stroke patients. The expression of lncRNA potassium voltage-gated channel subfamily Q member 1 opposite strand 1 (KCNQ1OT1) was upregulated in patients with recurrent ischemic events after TIA. Additionally, KCNQ1OT1 could be regarded as an independent predictor for subsequent ischemic stroke. The optimal diagnostic value was determined at 1.29 with a sensitivity of 63% and a specificity of 72%. Fewer patients would survive from further ischemic stroke with their KCNQ1OT1 level over 1.29. Furthermore, the expression of KCNQ1OT1 was elevated with a growing serum high-sensitivity C-reactive protein (hs-CRP) level. KCNQ1OT1 might be involved in the regulation of early inflammatory response during recurrence of TIA.

Risk of self-harm in post TIA patients: A population-based cohort study

ObjectiveThe purpose of this study was to determine whether individuals who have experienced a transient ischemic attack (TIA) have an increased risk of self-harm behaviors. MethodsIn this matched cohort study, we reviewed the electronic health records of all patients admitted for any reason to Hong Kong public hospitals between January 1, 1993, and December 31, 2019. We selected a post-TIA cohort consisting of 37,356 patients and a comparison cohort comprising 37,352 subjects. All participants enrolled in this study were followed up until a diagnosis of self-harm, death from other causes, or the end of 2020, whichever occurred first. Univariate Cox proportional hazards regression models were used to calculate the risk of self-harm since the onset of TIA. ResultsThroughout the 27-year study period, the number of individuals exhibiting self-harm behavior in the TIA and comparison groups was 1031 (2.76%) and 512 (1.37%), respectively. The TIA group had a higher proportion of subjects with self-harm (χ2 = 178, p < .001). The incidence rates of self-harm were 33.94 and 19.27 per 10,000 person-years in TIA patients and comparators, respectively. Compared with the comparators, the adjusted hazard ratio for self-harm in TIA patients was 1.63 (95% confidence interval, 1.46–1.82). ConclusionsTIA is associated with an increased risk of self-harm. Healthcare professionals should help identify patients at heightened risk and provide efficient and targeted prevention strategies for this population.

Power of Hypoperfusion in Predicting Recurrent Transient Ischemic Attacks: Protocol of a Prospective Cohort Study.

Background: Transient ischemic attack (TIA) has a high incidence of recurrent vascular events. Hypoperfusion is one of the factors that are closely correlated with 7-day recurrence of TIA. This study aimed to evaluate the power of hypoperfusion shown on magnetic resonance (MR) perfusion imaging in predicting the incidence of 7-day recurrence of ischemic events after TIA.Methods/Design: REATTACK is a prospective multi-centered cohort study on the correlation between MR perfusion and TIA recurrence. Ninety patients aged ≥18 years with recent (<7 days after onset) clinical TIA will be continuously included. All the patients will undergo diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) assessments within 24 h after the onset of TIA. The subjects will then be divided into a PWI positive group and a PWI negative group according to the time-to-maximum of the residue function (Tmax). PWI will be repeated after 7 days and in 3 months. The primary clinical outcome will be the recurrence of TIA within 7 days after the onset of TIA. Secondary outcomes will be the recurrence of TIA in 3 months and modified Rankin scale (mRS) score. A chi-square test will be performed to compare the difference in the incidence of recurrent TIA between the two groups, and rank sum test in the mRS score. Multivariate logistic regression will be simultaneously performed to analyze the risk factors for the recurrence of TIA.Discussion: The results of this study will confirm whether abnormal Tmax helps to identify the patients with TIA who have high risks of recurrent ischemic events. This would largely improve the prognosis of patients with TIA.Trial Registration: www.chictr.org.cn, registration number: ChiCTR2000031863, registered on 12 April 2020.

Benefits and Risks of Dual Versus Single Antiplatelet Therapy for Secondary Stroke Prevention: A Systematic Review for the 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack.

Dual antiplatelet therapy (DAPT) after ischemic stroke or transient ischemic attack may reduce recurrent stroke but also increase severe bleeding compared with single antiplatelet therapy (SAPT). The American Heart Association/American Stroke Association convened an evidence review committee to perform a systematic review and meta-analysis of the benefits and risks of DAPT compared with SAPT for secondary ischemic stroke prevention. The Medline, Embase, and Cochrane databases were searched on December 5, 2019, to identify phase III or IV randomized controlled trials (n≥100) from December 1999 to December 2019. We calculated unadjusted relative risks (RRs) and performed meta-analyses of studies based on the duration of treatment (short [≤90 days] versus long [>90 days]). Three short-duration randomized controlled trials were identified that enrolled mostly patients with minor stroke or high risk transient ischemic attack. In these trials, DAPT, compared with SAPT, was associated with a lower 90-day risk of recurrent ischemic stroke (pooled RR, 0.68 [95% CI, 0.55-0.83], I 2=37.1%). There was no significant increase in major bleeding with DAPT in short-duration trials (pooled RR, 1.88 [95% CI, 0.93-3.83], I 2=8.9%). In 2 long-duration treatment randomized controlled trials (mean treatment duration, 18-40 months), DAPT was not associated with a significant reduction in recurrent ischemic stroke (pooled RR, 0.89 [95% CI, 0.79-1.02], I 2=1.4%), but was associated with a higher risk of major bleeding (pooled RR, 2.42 [95% CI, 1.37-4.30], I 2=75.5%). DAPT was more effective than SAPT for prevention of secondary ischemic stroke when initiated early after the onset of minor stroke/high-risk transient ischemic attack and treatment duration was <90 days. However, when the treatment duration was longer and initiated later after stroke or transient ischemic attack onset, DAPT was not more effective than SAPT for ischemic stroke prevention and it increased the risk of bleeding.

Evaluation of Cerebral Blood Flow Dynamics in Transient Ischemic Attacks Patients with Fast Cine Phase Contrast Magnetic Resonance Angiography.

Fast cine phase contrast magnetic resonance angiography (PC-MRA) has the potential to provide a quantitative measurement method for the diagnosis and treatment of cerebrovascular disease. To evaluation the changes of cerebral blood flow and the characteristics of artery lesion distribution in the patients of transient ischemic attacks (TIA). In all, 98 normal subjects and 106 TIA patients who underwent MRI examination within 72 h after the last symptom onset including the DWI sequence to exclude acute cerebral infarction were enrolled. The blood flow of the cranial total, the area of the internal carotid artery and vertebral artery, the average velocity, and the average blood flow were obtained and compared in normal subjects and TIA group. Analysis of Variance (ANOVA), t-test, and Kruskal-Wallis test were used for statistical assessments. The total cerebral blood flow of the TIA group and normal control group was no significant statistical difference (P > 0.05). The total blood flow decreased with increasing age, and the TIA group was much lower than the control group. The blood flow of the right internal carotid artery in the TIA group had a significant difference compared with controls (P < 0.05). However, the same situation did not happen in both of the left internal carotid artery and vertebral artery. Phase contrast magnetic resonance imaging has the potential to evaluate the change of cerebral blood flow in TIA patients. The decrease in the total blood flow and the symptom onset of TIA is consistent. Phase contrast magnetic resonance imaging could provide guidance to the diagnosis of TIA.

Pitfall in the detection of acute lesions of transient ischemic attack with fluid-inversion prepared diffusion weighted imaging

Objective To explore the limits of fluid-inversion prepared diffusion weighted imaging (FLIPD) in detection of acute cerebral ischemic lesions. Methods From January 2012 to March 2014, forty-nine patients (33 males, 16 females, age (55.6±12.3) years) clinically diagnosed as transient ischemic attack (TIA) were included. Patients underwent brain MRI (conventional diffusion weighted imaging (DWI) and FLIPD) within 3 d after the onset of TIA. The detection ability of MRI with the two sequences was compared, and the relative signal intensity (rSI) and apparent diffusion coefficient (ADC) of acute ischemic lesions based on two sequences were compared. Kappa test and two-sample t test were used to analyze the data. Results A total of 87 acute ischemic lesions were detected in 21 patients by conventional DWI, and 54 were detected in 19 patients by FLIPD (Kappa=0.916, P<0.05). The rSI of ischemic lesions on FLIPD was significantly lower than that on conventional DWI (1.37±0.22 vs 1.57±0.26; t=6.647, P<0.001). The ADC value of ischemic lesions on FLIPD was slightly lower than that on conventional DWI: (0.54 ±0.10) ×10-3 mm2/s vs (0.57±0.13)×10-3 mm2/s (t=2.120, P<0.05). The missed lesions on FLIPD were located in the white matter (n=18), cerebellum and brainstem (n=8), and the cortex (n=7). Conclusions A slight diffuse abnormality may be missed on FLIPD, so this method is not suitable for the detection of acute ischemic lesions. FLIPD technology still needs improvement. Key words: Ischemic attack, transient; Diffusion magnetic resonance imaging; Fluid attenuated inversion recovery sequence

Simulation for dynamics of transient ischemic attacks with thermal infrared imaging

Stroke is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function in a patient. According to current methodological recommendations, it is possible to perform surgical and drug treatment to minimize the damage from acute stroke in the first 3-6 hours after the onset of transient ischemic attacks, which is often difficult to identity for emergency physician or clinician. Thermal infrared imaging could serve as a fast non-invasive test to detect asymmetrical pattern in facial temperature of patient as a predictor for vessel occlusion during acute stroke. We develop a software-driven model to simulate for dynamics of facial surface temperature distribution with transient ischemic attacks. The implemented model is designed to develop and debug algorithms for automated analysis of the temperature dysregulation at the processing of patient thermal infrared recording.

ED Referral Dramatically Reduces Delays of Initial Evaluation in a French TIA Clinic.

Background: The risk of recurrent brain infarction (BI) is high within the first hours after a transient ischemic attack (TIA). Emergent, specialized, and tailored patient management in a TIA program reduces the risk of recurrent BI after TIA by 80%. New antithrombotic strategies have been successfully tested within 12 h after TIA onset. We aim to investigate the factors associated with a delay of more than 12 h from TIA onset to evaluation in our TIA clinic.Methods: In consecutive patients evaluated in our TIA clinic from 01/2012 to 11/2013, we prospectively collected delays from onset to arrival, baseline characteristics, discharge diagnosis and recurrent BI at 1 week. Referring pathways were dichotomized between office-based physicians (OBP) and emergency departments (ED). Univariate and multivariate logistic regression were performed.Results: 354 patients were evaluated. Mean (+/– SD) age was 61 years (+/−18). Median (IQR) ABCD2 score was 3 (2–4). Median (IQR) delay from onset to evaluation was 8 h (4–48). Overall, 185 (52%) were referred by OBP vs. 169 (48%) by ED. Evaluation was initiated within 12 h among 201 (57%) patients. After logistic regression, OBP referral was by comparison with ED the only independent factor associated with an evaluation delay >12 h (OR 5.7, 95% CI: 3.5–9.3, p < 0.0001).Conclusion: Our results suggest that preliminary assessment by OBP may increase the delay to initiate the emergent evaluation of TIA patients. Promoting direct admission to TIA clinics through ED may be an efficient alternative for high risk TIAs.

Risk Factors Associated with Neurologic Deterioration After Combined Direct and Indirect Revascularization in Patients with Moyamoya Disease on the East Coast of China

Neurologic deterioration is the primary distinctive complication after revascularization surgery in patients with moyamoya disease (MMD). The present study investigated the risk factors for neurologic deterioration after combined direct and indirect revascularization in patients with MMD. A retrospective review of 123 patients with MMD undergoing 138 combined direct and indirect revascularization procedures was performed. Demographics, clinical manifestation, medical history, neurologic deterioration complications, and relevant information of the operation were recorded. There were 25 (18.12%) postoperative neurologic deterioration complications (13 reversible neurologic deficits, 9 infarctions with neurologic sequelae, and 3 hemorrhages). Preoperative multiple symptom episodes and one-staged bilateral revascularization were significantly correlated with postoperative neurologic deterioration complications (P < 0.05 and P < 0.01, respectively). The incidence rate (26.39%) of postoperative neurologic deterioration in ischemic MMDs was significantly greater than hemorrhagic MMDs (7.69%; P < 0.01) In total, 34.78% of patients with transient ischemic attack onset and 22.45% of patients with infarction onset suffered from postoperative neurologic deterioration, and there was no significant difference between them (P > 0.05). Postoperative neurologic deterioration complications had no significant correlation with sex, age at the time of surgery, type of surgical procedure, unilateral MMD or not, interval between the last attack and operation, and history of thyroid disease, hypertension, and autoimmune disease. Preoperative multiple symptom episodes and one-staged bilateral revascularization are risk factors associated with postoperative neurologic deterioration in patients with MMD. Therefore, 2 unilateral revascularization procedures performed successively rather than one-staged bilateral revascularization procedures should be performed in patients with bilateral MMD.

Prominent deep medullary veins: a predictive biomarker for stroke risk from transient ischemic attack?

Background Deep medullary veins (DMVs) are a biomarker of severity and prognosis in patients with acute cerebral infarction. However, their clinical significance remains unclear in patients with transient ischemic attack (TIA). Purpose To determine whether prominent deep medullary veins (PDMVs) are a predictive biomarker for stroke risk after TIA. Material and Methods Clinical and imaging data of 49 patients with TIA and 49 sex- and age-matched controls were studied. PDMVs were defined as DMVs with a score of 3 (TDMVs) or asymmetric DMVs (ADMVs), and the relationship between PDMVs and clinical features was analyzed. The DMV score based on susceptibility weighted imaging (SWI) ranged from 0 (not visible) to 3 (very prominent) and was calculated for both hemispheres separately. A different score in each hemisphere was defined as ADMVs and an equal score was defined as symmetric DMVs. The asymmetry and score of DMVs were compared between the two groups and with respect to the time from TIA onset to imaging analysis. Results Agreement between neuroradiologists for the DMV asymmetry/score on SWI was excellent. The frequency of ADMVs and TDMVs was significantly higher in patients with TIA than controls ( P < 0.05). The patients showed no correlation between the time from TIA onset to imaging and the DMV asymmetry/score ( P > 0.05); PDMVs were not correlated with age, blood pressure, or diabetes. However, PDMVs were associated with the ABCD2 score (≥4), clinical symptoms, and duration of TIA (≥10 min). Conclusion Prominent deep medullary veins is a predictive biomarker for the risk of stroke in many patients having suffered from TIA.

Correlation analysis between the LDL-C in serum and the onset of transient ischemic attack caused by CSVD.

The aim of this study was to investigate the correlation between the low-density lipoprotein cholesterol (LDL-C) in serum and the onset of transient ischemic attack caused by cerebral small vascular disease (CSVD). Between September 2012 and September 2015, 249 patients who were diagnosed as CSVD were randomly enrolled in this study. According to MRI results, patients were divided into the patient and control groups. In the patient group, the patients were further subdivided into the white matter lesion (WML) group (n=86) and lacunar infarction (LI) group (n=53). Head MRI and/or CT were conducted on all the patients. This included T1 and T2 phases, diffusion weighted imaging (DWI) and fluid attenuated inversion recovery (FLAIR). Additionally, mini-mental status examination (MMSE) test and Montreal cognitive assessment (MoCA) test were carried out on all the patients. As a result, the age, total cholesterol (TC) level and low-density lipoprotein (LDL) levels in the patient group were higher than those in the control group (p<0.05). The MMSE and MoCA scores in the patient group were significantly lower than those in the control group (p<0.05). With all the risk factors being set as independent variables and small vessel disease (SVD) as the dependent variable, we performed the logistic regression analysis and correlation analysis for paired data, and found that the increase in LDL was correlated to the onset of SVD, OR=1,321. After adjustment of other risk factors, we enrolled the level of triglyceride (TG) into the multivariable analysis and obtained a statistically significant difference (p<0.05). In conclusion, LDL is a major risk factor affecting the onset of transient ischemic attack (TIA) induced by CSVD. Patients with hyperlipidemia should receive head MRI or CT examination to eliminate the probability of the existence of CSVD. To reduce the occurrence of adverse events in clinical practice, we can perform early intervention in SVD by decreasing the level of LDL, improving the endothelial function of small vessels and applying the anti-inflammation and nerve-protection methods.

Optimal Timing of Diffusion-Weighted Imaging to Avoid False-Negative Findings in Patients With Transient Ischemic Attack.

We aimed to investigate the optimal timing of diffusion-weighted imaging (DWI) in patients with transient ischemic attack (TIA). Seventy-three consecutive patients with TIA underwent DWI on admission (initial DWI) and at 24 hours after admission (second DWI). Patients were divided into 2 groups based on initial DWI findings in relation to the second examination: false negative (group 1) and other (group 2). The probability of initial false-negative findings was determined for each hour from TIA onset to initial DWI. Multivariate analysis was used to evaluate the independent risk factors associated with false-negative findings on initial DWI. Of the 73 patients examined (56 men; mean age, 68 years), 9 (12%) were categorized into group 1. The latency from TIA onset to initial DWI was 1.7±0.6 hours for group 1 (range, 1-2.8 hours) and 3.3±2.6 hours for group 2 (range, 35 minutes to 12 hours). The probability of false-negative findings on initial DWI decreased in a time-dependent manner (25%, 21%, and 7% for 1, 2, and 3 hours, respectively), and no false-negative findings were observed on initial DWI performed at >3 hours from symptom onset. Short latency (≤2 hours) from TIA onset to initial DWI was an independent risk factor related to false-negative findings (odds ratio, 13.11; 95% confidence interval, 1.07-161.38; P=0.045). If the duration between TIA symptom onset and initial DWI is <2 hours, a repeat examination should be performed to minimize the risk of false-positive findings.

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.

Incidence, predictors, and etiology of subsequent ischemic stroke within one year after transient ischemic attack.

Background Incidence and predictors of ischemic stroke in patients with transient ischemic attack (TIA) have not been fully clarified outside Europe and North America. Aims We undertook the present prospective, multicenter study to clarify the incidence, predictors, and etiology of ischemic stroke within one year of TIA onset in Japan. Methods The study subjects were patients within seven days of TIA onset who were enrolled in a prospective register from 57 hospitals between June 2011 and December 2013. The primary endpoint was occurrence of ischemic stroke. Results Of 1365 consecutive patients, 1245 were followed for one year after TIA onset; 101 (8.1%) experienced ischemic stroke during follow-up. The leading subtype of ischemic stroke was small-vessel occlusion (SVO) followed by large-artery atherosclerosis (LAA) attributable to intracranial artery diseases. When dividing ischemic stroke events between those occurring within the first 90 days after TIA onset and those occurring after the first 90 days, the leading subtype of ischemic stroke within the first 90 days after TIA onset was SVO, followed by LAA attributable to intracranial artery diseases. In comparison, the subtypes most commonly seen beyond the first 90 days after TIA onset were cardioembolic and LAA attributable to intracranial artery disease. The one-year risk of ischemic stroke increased significantly as ABCD2 score increased, at 6.2% for 0-3 points, 7.2% for 4-5 points, and 11.6% for 6-7 points. Conclusions The one-year ischemic stroke risk after TIA was about 8% and was associated with the ABCD2 score. The most common subtype of subsequent ischemic stroke was SVO.

Abstract TP174: Incidence Rate of Transient Ischemic Attack and Subsequent Stroke Incidence Rates: a Meta-analysis

Background and Purpose: Only a limited number of studies have examined the incidence of transient ischemic attack (TIA) along with the subsequent stroke incidence. There is no meta-analysis of the incident TIA along with the subsequent stroke incidence. The purpose of the present meta-analysis was to identify the annual incidence rate of TIA according to sex and age categories and the incidence rate of stroke after the onset of TIA. Methods: Using PubMed, we performed a systematic review and meta-analysis of prospective cohort studies of TIA published between 1985 and July 2015. The search was limited to English-language studies and reports showing the number of subjects according to sex and age categories. The incidence of stroke after TIA onset was calculated. Among 98 articles revealed by the PubMed search, eight studies of Western populations (1,422,037 men and 1,467,254 women) and the single study of a Japanese population met the inclusion criteria for the incidence of TIA. Among 115 articles by the PubMed search, 14 studies (8,763 patients with TIA) were included in our identification of the incidence rate of stroke after TIA search. Results: During the follow-ups, the incidence rates of TIA were 1.38 and 1.29 per 1,000 person-years in the Western men and women, respectively. The incidence rates of TIA in Western populations according to the age categories (&lt;45, 45-54, 55-64, 65-74, 75-84, and ≥85 years old) were 0.05, 0.4, 1.1, 2.4, 4.8, and 5.2 per 1,000 person-years in the men and 0.03, 0.3, 0.7, 1.5, 3.7, and 5.4 per 1,000 person-years in the women, respectively. In the Japanese population, the incidence rates of TIA were 0.78 and 0.38 per 1,000 person-years in the men and women, respectively. The incidence rates of stroke which were all Western countries, were 3.8%, 6.3%, 9.7%, 10.5%, and 17.2% at 2 days, 1 week, and 1, 3, and 6 months after the onset of TIA, respectively. Conclusions: In this meta-analysis, the incidence rate of TIA in Western populations was 1.3 per 1,000 person-years, which is higher than that in Japanese population. One in 10 patients and one in 6 patients with TIA subsequently suffered from a stroke during a month and a half year, respectively. For stroke prevention, it is important that thorough care is provided for TIAs that occur during the acute phase.

Abstract TP191: Sex Differences in Subsequent Ischemic Stroke After Transient Ischemic Attack: Results From a Prospective Multicenter Study

Background and Purpose: Many studies have been reported about the differences between women and men in acute ischemic stroke, but there was limited data for transient ischemic attack (TIA). The aim of this study was to clarify the sex differences in clinical characteristics and subsequent ischemic stroke in TIA patients. Methods: The PROMISE-TIA registry was a multicenter prospective study in Japan. From June 2011 to December 2013, 1365 patients within 7 days of TIA onset were enrolled. 1314 patients were followed for 90 days and 1226 patients for 1 year. The age-adjusted hazard ratio (HR) for ischemic stroke after TIA was calculated by using Cox regression to assess sex differences. Results: Overall, 483 patients were women and 882 were men. Compared with women, men were younger (69±12 years vs. 71±14 years, p=0.005), had more frequently diabetes mellitus (25% vs. 17%, p=0.0007), and had more frequently taken antiplatelet drugs before TIA onset (32% vs. 26%, p=0.002). The current smoking and drinking rate was higher in men than women (29% vs. 8%, p&lt;0.0001, 55% vs. 15%, p&lt;0.0001, respectively). As for the imaging findings, men had more frequently extracranial carotid stenosis (20% vs. 7%, p&lt;0.0001) and positive DWI lesions (35% vs. 29%, p=0.01). The ABCD2 score was similar in both groups but the incidence of ischemic stroke was significantly higher in men than women both 90 days and 1 year (6.6% vs. 4.1%, HR 1.68; 95%CI 1.01-2.90 and 9.3% vs. 4.4%, HR 1.62; 95%CI 1.05-2.58, respectively). There was no significant difference in stroke subtypes between women and men. Conclusions: Although there was no significant difference in the ABCD2 score between the sexes, men had a higher risk of ischemic stroke within 90 days or 1 year after TIA onset.