J Stroke.  2019 May;21(2):184-189. 10.5853/jos.2018.03601.

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

• 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

• KMID: 2449895
• DOI: http://doi.org/10.5853/jos.2018.03601

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.

Keyword

Stroke; Recurrence; Ischemic attack, transient

MeSH Terms

Atherosclerosis
Classification
Cohort Studies
Embolism
Follow-Up Studies
Humans
Ischemic Attack, Transient*
Prospective Studies
Recurrence*
Stroke*