Long-Term Stroke Recurrence after Transient Ischemic Attack: Implications of Etiology
- Author:
Angel OIS
1
;
Elisa CUADRADO-GODIA
;
Eva GIRALT-STEINHAUER
;
Jordi JIMENEZ-CONDE
;
Carolina SORIANO-TARRAGA
;
Ana RODRÍGUEZ-CAMPELLO
;
Carla AVELLANEDA
;
Diego CASCALES
;
Isabel FERNANDEZ-PEREZ
;
Jaume ROQUER
Author Information
- Publication Type:Original Article
- Keywords: Stroke; Recurrence; Ischemic attack, transient
- MeSH: Atherosclerosis; Classification; Cohort Studies; Embolism; Follow-Up Studies; Humans; Ischemic Attack, Transient; Prospective Studies; Recurrence; Stroke
- From:Journal of Stroke 2019;21(2):184-189
- CountryRepublic of Korea
- Language:English
- 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 one-point 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.
