Long-Term Stroke Recurrence after Transient Ischemic Attack: Implications of Etiology

Abstract

Background and Purpose To analyze long-term stroke recurrence (SR) characteristics after transient ischemic attack (TIA) according to initial etiological classification. Methods A prospective cohort of 706 TIA patients was followed up in a single tertiary stroke center. Endpoint was SR. Etiologic subgroup was determined according to the evidence-based causative classification system. Location of TIA and SR was recorded as right, left, or posterior territory. Disability stroke recurrence (DSR) was defined as modified Rankin Scale (mRS) score >1 or a onepoint increase in those with previous mRS >1 at 3-month follow-up. Results During a follow-up of 3,493 patient-years (mean follow-up of 58.9±35.9 months), total SR was 125 (17.7%), corresponding to 3.6 recurrences per 100 patient-years. The etiology subgroups with a higher risk of SR were the unclassified (more than one cause) and large-artery atherosclerosis (LAA) categories. Of the SR cases, 88 (70.4%) had the same etiology as the index TIA; again, LAA etiology was the most frequent (83.9%). Notably, cardioaortic embolism was the most frequent cause (62.5%) of SR in the subgroup of 24 patients with undetermined TIA. Overall, SR occurred in the same territory in 74 of 125 patients (59.2%), with significant differences between etiological TIA subgroups ( P =0.015). Eighty-two of 125 (65.6%) with SR had DSR, without differences between etiologies ( P =0.453). Conclusions SR occurred mainly with the same etiology and location as initial TIA, although undetermined TIA was associated with a high proportion of cardioaortic embolism SR. More than half of the recurrences caused some disability, regardless of etiology.

Recurrent Ischemic and Hemorrhagic Stroke in Cameroon: A Case-Control Study

“…An index stroke damages the cerebral blood vessels making them prone to subsequent strokes [29]. Also, risk factors that alter the function and lumen of blood vessels such as atherosclerosis increase the probability of recurrence in the same territory as the index stroke [30]. Due to the complexity of stroke recurrence, multiple studies are underway to understand better the factors surrounding lateralization of stroke recurrence [5].…”

Long‐term risk of stroke and its predictors in transient ischaemic attack patients in Germany

“…In recent decades, several studies conducted in a wide range of different settings have focused on the association between transient ischaemic attack (TIA) and the risk of stroke [3][4][5][6][7][8][9][10][11][12][13][14]. Whilst these results have shed some light on the association between TIA and stroke, they also have had several limitations that must be acknowledged.…”

Enhancing stroke risk prediction in patients with transient ischemic attack: insights from a prospective cohort study implementing fast-track care

“…Of interest, no specific TIA etiology was found to independently predict a higher stroke risk within our population. Prior studies found that large artery atherosclerosis (LAA) TIA etiology was independently associated with a higher short-term risk of stroke recurrence, ( 34 , 35 ) while no etiological TIA subtype has been identified as robust predictor of increased stroke risk in the long-term ( 36 ). We may speculate that implementing urgent measures to prevent ischemic recurrences within our cohort, as provided by our fast-track care, may have mitigated the unfavorable effect of LAA etiology on future stroke risk.…”