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KMID : 1142120190210020184
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Journal of Stroke
2019 Volume.21 No. 2 p.184 ~ p.189
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Long-Term Stroke Recurrence after Transient Ischemic Attack: Implications of Etiology
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Ois Angel
Cuadrado-Godia Elisa
Giralt-Steinhauer Eva
Jimenez-Conde Jordi
Soriano-Tarraga Carolina
Rodriguez-Campello Ana
Avellaneda Carla
Cascales Diego
Fernandez-Perez Isabel
Roquer Jaume
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Abstract
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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 onepoint 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.
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KEYWORD
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Stroke, Recurrence, Ischemic attack, transient
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