Long-Term Stroke Recurrence after Transient Ischemic Attack : Implications of Etiology
Ois, Angel (Institut Hospital del Mar d'Investigacions Mèdiques)
Cuadrado-Godia, Elisa (Hospital del Mar (Barcelona, Catalunya))
Giralt Steinhauer, Eva (Universitat Pompeu Fabra. Departament de Ciències Experimentals i de la Salut)
Jimenez-Conde, Jordi (Institut Hospital del Mar d'Investigacions Mèdiques)
Soriano-Tarraga, Carolina (Hospital del Mar (Barcelona, Catalunya))
Rodríguez Campello, Ana (Universitat Autònoma de Barcelona. Departament de Medicina)
Avellaneda-Gómez, C (Institut Hospital del Mar d'Investigacions Mèdiques)
Cascales, Diego (Hospital del Mar (Barcelona, Catalunya))
Fernandez-Perez, Isabel (Hospital del Mar (Barcelona, Catalunya))
Roquer, Jaume (Hospital del Mar (Barcelona, Catalunya))

Date:	2019
Abstract:	To analyze long-term stroke recurrence (SR) characteristics after transient ischemic attack (TIA) according to initial etiological classification. 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. 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). 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.
Grants:	Instituto de Salud Carlos III RD12-0042-0020
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Stroke ; Recurrence ; Ischemic attack, transient
Published in:	Journal of Stroke, Vol. 21 (april 2019) , p. 184-189, ISSN 2287-6405

DOI: 10.5853/jos.2018.03601
PMID: 30991798

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