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

• DOI: 10.5853/jos.2018.03601
• Publication Date: 2019-04-17T08:02:52Z
• Authors: Angel Ois; Elisa Cuadrado-Godia; Eva Giralt-Steinh...; Jordi Jimenez-Conde; Carolina Soriano-...; Ana Rodríguez-Cam...; Carla Avellaneda; Diego Cascales; Isabel Fernandez-...; Jaume Roquer
• Keywords: recurrence; Transient; Ischemic attack; stroke; Ischemic attack, transient; 3. Good health; Stroke; 03 medical and health sciences; 0302 clinical medicine; Recurrence; RC666-701; ischemic attack, transient; Diseases of the circulatory (Cardiovascular) system; Original Article

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.