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

• Published in: Journal of stroke Vol. 21; no. 2; pp. 184 - 189
• Main Authors: Ois, Angel, Cuadrado-Godia, Elisa, Giralt-Steinhauer, Eva, Jimenez-Conde, Jordi, Soriano-Tarraga, Carolina, Rodríguez-Campello, Ana, Avellaneda, Carla, Cascales, Diego, Fernandez-Perez, Isabel, Roquer, Jaume
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Stroke Society 01.05.2019; 대한뇌졸중학회
• Subjects: ischemic attack, transient; Original; recurrence; stroke; 신경과학; Ischemic attack, transient; Recurrence; Stroke
• ISSN: 2287-6391; 1229-4101; 2287-6405
• DOI: 10.5853/jos.2018.03601

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.