Long-term stroke recurrence after transient ischemic attack: Implications of etiology

Angel Ois, Elisa Cuadrado-Godia, Eva Giralt-Steinhauer, Jordi Jimenez-Conde, Carolina Soriano-Tarraga, Ana Rodríguez-Campello, Carla Avellaneda, Diego Cascales, Isabel Fernandez-Perez, Jaume Roquer

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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.

Original languageEnglish
Pages (from-to)184-189
Number of pages6
JournalJournal of Stroke
Volume21
Issue number2
DOIs
StatePublished - May 2019
Externally publishedYes

Keywords

  • Ischemic attack
  • Recurrence
  • Stroke
  • Transient

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    Ois, A., Cuadrado-Godia, E., Giralt-Steinhauer, E., Jimenez-Conde, J., Soriano-Tarraga, C., Rodríguez-Campello, A., Avellaneda, C., Cascales, D., Fernandez-Perez, I., & Roquer, J. (2019). Long-term stroke recurrence after transient ischemic attack: Implications of etiology. Journal of Stroke, 21(2), 184-189. https://doi.org/10.5853/jos.2018.03601