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Palomeras Soler E, Fossas Felip P, Cano Orgaz A, Sanz Cartagena P, Casado Ruiz V, Muriana Batista D. Evaluación rápida del ataque isquémico transitorio en un hospital sin guardias de neurología. Neurologia 2015; 30:325-30. [DOI: 10.1016/j.nrl.2013.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 10/24/2013] [Accepted: 12/29/2013] [Indexed: 01/08/2023] Open
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Palomeras Soler E, Fossas Felip P, Cano Orgaz A, Sanz Cartagena P, Casado Ruiz V, Muriana Batista D. Rapid assessment of transient ischaemic attack in a hospital with no on-call neurologist. NEUROLOGÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.nrleng.2015.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Félix-Redondo F, Consuegra-Sánchez L, Ramírez-Moreno J, Lozano L, Escudero V, Fernández-Bergés D. Ischemic stroke mortality tendency (2000–2009) and prognostic factors. ICTUS Study-Extremadura (Spain). Rev Clin Esp 2013. [DOI: 10.1016/j.rceng.2013.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Félix-Redondo F, Consuegra-Sánchez L, Ramírez-Moreno J, Lozano L, Escudero V, Fernández-Bergés D. Tendencia de la mortalidad por ictus isquémico (2000-2009) y factores pronósticos. Estudio ICTUS-Extremadura. Rev Clin Esp 2013; 213:177-85. [DOI: 10.1016/j.rce.2013.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 01/26/2013] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
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Purroy F, Jiménez-Caballero PE, Mauri-Capdevila G, Torres MJ, Gorospe A, Ramírez Moreno JM, de la Ossa NP, Cánovas D, Arenillas J, Alvarez-Sabín J, Martínez Sánchez P, Fuentes B, Delgado-Mederos R, Martí-Fàbregas J, Rodríguez Campello A, Masjuán J. Predictive value of brain and vascular imaging including intracranial vessels in transient ischaemic attack patients: external validation of the ABCD3-I score. Eur J Neurol 2013; 20:1088-93. [PMID: 23530724 DOI: 10.1111/ene.12141] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 02/14/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Recently, brain and vascular imaging have been added to clinical variables to identify patients with transient ischaemic attack (TIA) with a high risk of stroke recurrence. The aim of our study was to externally validate the ABCD3-I score and the same score taking into account intracranial circulation. METHODS We analyzed data from 1137 patients with TIA from the PROMAPA study who underwent diffusion-weighted magnetic resonance imaging (DWI) within 7 days of symptom onset. Clinical variables and diagnostic work-up were recorded prospectively. The end-points were subsequent stroke at 7 and 90 days follow-up. RESULTS A total of 463 (40.7%) subjects fulfilled all inclusion criteria. During follow-up, eight patients (1.7%) had a stroke within 7 days, and 14 (3.1%) had a stroke within 3 months. In the Cox proportional hazard multivariate analyses, the combination of large-artery atherosclerosis and positive DWI remained as independent predictors of stroke recurrence at 7- and 90-day follow-up [HR 8.23, 95% confidence interval (CI) 2.89-23.46, P < 0.001]. The ABCD3-I score was a powerful predictor of subsequent stroke. The area under the receiver operating characteristic curve was 0.83 (95% CI 0.72-0.93) at 7 days and 0.69 (95% CI 0.53-0.85) at 90 days. When we include intracranial vessel disease in the score, the area under the curve increases but the difference observed was non-significant. CONCLUSION The inclusion of vascular and neuroimaging information to clinical scales (ABCD3-I score) provides important prognostic information and also helps management decisions, although it cannot give a complete distinction between high-risk and low-risk groups.
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Affiliation(s)
- F Purroy
- Stroke Unit, Hospital Universitari Arnau de Vilanova, Lleida, Spain.
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Lovrencic-Huzjan A, Rundek T, Katsnelson M. Recommendations for management of patients with carotid stenosis. Stroke Res Treat 2012; 2012:175869. [PMID: 22645702 PMCID: PMC3356946 DOI: 10.1155/2012/175869] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 01/05/2012] [Accepted: 01/24/2012] [Indexed: 02/03/2023] Open
Abstract
Stroke is a one of the leading causes of morbidity and mortality in the world. Carotid atherosclerosis is recognized as an important factor in stroke pathophysiology and represents a key target in stroke prevention; multiple treatment modalities have been developed to battle this disease. Multiple randomized trials have shown the efficacy of carotid endarterectomy in secondary stroke prevention. Carotid stenting, a newer treatment option, presents a less invasive alternative to the surgical intervention on carotid arteries. Advances in medical therapy have also enabled further risk reduction in the overall incidence of stroke. Despite numerous trials and decades of clinical research, the optimal management of symptomatic and asymptomatic carotid disease remains controversial. We will attempt to highlight some of the pivotal trials already completed, discuss the current controversies and complexities in the treatment decision-making, and postulate on what likely lies ahead. This paper will highlight the complexities of decision-making optimal treatment recommendations for patients with symptomatic and asymptomatic carotid stenosis.
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Affiliation(s)
- Arijana Lovrencic-Huzjan
- University Department of Neurology, University Hospital Center “Sisters of Mercy,” 10000 Zagreb, Croatia
| | - Tatjana Rundek
- Clinical Translational Research Division, Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Michael Katsnelson
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
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Purroy F, Jiménez Caballero P, Gorospe A, Torres M, Álvarez-Sabin J, Santamarina E, Martínez-Sánchez P, Cánovas D, Freijo M, Egido J, Girón J, Ramírez-Moreno J, Alonso A, Rodríguez-Campello A, Casado I, Delgado-Medeiros R, Martí-Fàbregas J, Fuentes B, Silva Y, Quesada H, Cardona P, Morales A, de la Ossa N, García-Pastor A, Arenillas J, Segura T, Jiménez C, Masjuán J. Prediction of Early Stroke Recurrence in Transient Ischemic Attack Patients from the PROMAPA Study: A Comparison of Prognostic Risk Scores. Cerebrovasc Dis 2012; 33:182-9. [DOI: 10.1159/000334771] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2011] [Indexed: 11/19/2022] Open
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Bhatt A, Jani V. The ABCD and ABCD2 Scores and the Risk of Stroke following a TIA: A Narrative Review. ISRN NEUROLOGY 2011; 2011:518621. [PMID: 22389822 PMCID: PMC3263538 DOI: 10.5402/2011/518621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 04/10/2011] [Indexed: 12/03/2022]
Abstract
The California, ABCD, and ABCD2 risk scores (ABCD system) were developed to help stratify short-term stroke risk in patients with TIA (transient ischemic attack). Beyond this scope, the ABCD system has been extensively used to study other prognostic information such as DWI (diffusion-weighted imaging) abnormalities, large artery stenosis, atrial fibrillation and its diagnostic accuracy in TIA patients, which are independent predictors of subsequent stroke in TIA patients. Our comprehensive paper suggested that all scores have and equivalent prognostic value in predicting short-term risk of stroke; however, the ABCD2 score is being predominantly used at most centers. The majority of studies have shown that more than half of the strokes in the first 90 days, occur in the first 7 days. The majority of patients studied were predominantly classified to have a higher ABCD/ABCD2 > 3 scores and were particularly at a higher short-term risk of stroke or TIA and other vascular events. However, patients with low risk ABCD2 score < 4 may have high-risk prognostic indicators, such as diffusion weighted imaging (DWI) abnormalities, large artery atherosclerosis (LAA), and atrial fibrillation (AF). The prognostic value of these scores improved if used in conjunction with clinical information, vascular imaging data, and brain imaging data. Before more data become available, the diagnostic value of these scores, its applicability in triaging patients, and its use in evaluating long-term prognosis are rather secondary; thus, indicating that the primary significance of these scores is for short-term prognostic purposes.
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Affiliation(s)
- Archit Bhatt
- Spectrum Health, Grand Rapids, MI 49503, USA
- Michigan State University College of Human Medicine, Grand Rapids, MI 49503, USA
| | - Vishal Jani
- Department of Neurology, Michigan State University, East Lansing, MI 48824-1046, USA
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Purroy F, Begué R, Gil MI, Quílez A, Sanahuja J, Brieva L, Piñol-Ripoll G. Patterns of diffusion-weighted magnetic resonance imaging associated with etiology improve the accuracy of prognosis after transient ischaemic attack. Eur J Neurol 2010; 18:121-8. [DOI: 10.1111/j.1468-1331.2010.03080.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Purroy F, Piñol-Ripoll G, Quílez A, Sanahuja J, Brieva L, Suárez Luis I. Validación de las escalas ABCDI y ABCD2I en el registro de pacientes con ataque isquémico transitorio de Lleida (REGITELL). Med Clin (Barc) 2010; 135:351-6. [DOI: 10.1016/j.medcli.2009.10.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 10/12/2009] [Accepted: 10/20/2009] [Indexed: 11/17/2022]
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Ataque isquémico transitorio: el fin justifica los medios. Med Clin (Barc) 2010; 135:360-1. [DOI: 10.1016/j.medcli.2010.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 04/20/2010] [Indexed: 11/22/2022]
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Easton JD, Feldmann E. A new technique to stratify stroke risk in transient ischemic attack patients? Ann Neurol 2010; 68:1-2. [DOI: 10.1002/ana.22039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Purroy F, Begué R, Quílez A, Piñol-Ripoll G, Sanahuja J, Brieva L, Setó E, Gil MI. Implicaciones diagnósticas del perfil de recurrencia tras un ataque isquémico transitorio. Med Clin (Barc) 2009; 133:283-9. [DOI: 10.1016/j.medcli.2008.10.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Accepted: 12/10/2008] [Indexed: 11/29/2022]
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Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Feldmann E, Hatsukami TS, Higashida RT, Johnston SC, Kidwell CS, Lutsep HL, Miller E, Sacco RL. Definition and Evaluation of Transient Ischemic Attack. Stroke 2009; 40:2276-93. [PMID: 19423857 DOI: 10.1161/strokeaha.108.192218] [Citation(s) in RCA: 1188] [Impact Index Per Article: 79.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Purroy F, Montaner J, Molina CA, Delgado P, Ribo M, Álvarez-Sabín J. Response to Letter by Poppe et al. Stroke 2008. [DOI: 10.1161/strokeaha.108.515676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Francisco Purroy
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
| | - Joan Montaner
- Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
| | - Carlos A. Molina
- Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
| | - Pilar Delgado
- Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
| | - Marc Ribo
- Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
| | - José Álvarez-Sabín
- Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
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Purroy F, Montaner J, Molina CA, Delgado P, Ribo M, Álvarez-Sabín J. Patterns and Predictors of Early Risk of Recurrence After Transient Ischemic Attack With Respect to Etiologic Subtypes. Stroke 2007; 38:3225-9. [PMID: 17962602 DOI: 10.1161/strokeaha.107.488833] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Francisco Purroy
- From the Stroke Unit (F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, Spain; and the Neurovascular Unit (J.M., C.A.M., P.D., M.R., J.A.-S.), Department of Neurology, Universitat Autònoma de Barcelona, Hospital Universitari de la Vall d’Hebron, Barcelona, Spain
| | - Joan Montaner
- From the Stroke Unit (F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, Spain; and the Neurovascular Unit (J.M., C.A.M., P.D., M.R., J.A.-S.), Department of Neurology, Universitat Autònoma de Barcelona, Hospital Universitari de la Vall d’Hebron, Barcelona, Spain
| | - Carlos A. Molina
- From the Stroke Unit (F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, Spain; and the Neurovascular Unit (J.M., C.A.M., P.D., M.R., J.A.-S.), Department of Neurology, Universitat Autònoma de Barcelona, Hospital Universitari de la Vall d’Hebron, Barcelona, Spain
| | - Pilar Delgado
- From the Stroke Unit (F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, Spain; and the Neurovascular Unit (J.M., C.A.M., P.D., M.R., J.A.-S.), Department of Neurology, Universitat Autònoma de Barcelona, Hospital Universitari de la Vall d’Hebron, Barcelona, Spain
| | - Marc Ribo
- From the Stroke Unit (F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, Spain; and the Neurovascular Unit (J.M., C.A.M., P.D., M.R., J.A.-S.), Department of Neurology, Universitat Autònoma de Barcelona, Hospital Universitari de la Vall d’Hebron, Barcelona, Spain
| | - José Álvarez-Sabín
- From the Stroke Unit (F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, Spain; and the Neurovascular Unit (J.M., C.A.M., P.D., M.R., J.A.-S.), Department of Neurology, Universitat Autònoma de Barcelona, Hospital Universitari de la Vall d’Hebron, Barcelona, Spain
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Giles MF, Rothwell PM. Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol 2007; 6:1063-72. [PMID: 17993293 DOI: 10.1016/s1474-4422(07)70274-0] [Citation(s) in RCA: 467] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Stroke is often preceded by transient ischaemic attack (TIA), but studies of stroke risk after TIA are logistically difficult and have yielded conflicting results. However, reliable estimation of this risk is necessary for planning effective service provision, clinical trials, and public education. We therefore did a systematic review of all studies of stroke risk early after TIA. METHODS All studies of stroke risk within 7 days of TIA were identified by use of electronic databases and by hand searches of reference lists, relevant journals, and conference abstracts. Stroke risks at 2 days and 7 days after TIA were calculated overall and analyses for heterogeneity were done, if possible, after categorisation by study method, setting, population, and treatment. FINDINGS 18 independent cohorts were included, which reported stroke risk in 10 126 TIA patients. The pooled stroke risk was 5.2% (95% CI 3.9-6.5) at 7 days, but there was substantial heterogeneity between studies (p<0.0001), with risks ranging from 0% to 12.8%. However, the risks reported in individual studies over different durations of follow-up were highly correlated (0-7 days vs 8-90 days, r=0.89, p<0.0001), and the heterogeneity between studies was almost fully explained by study method, setting, and treatment. The lowest risks were seen in studies of emergency treatment in specialist stroke services (0.9% [95% CI 0.0-1.9], four studies) and the highest risks in population-based studies without urgent treatment (11.0% [8.6-13.5], three studies). Results were similar for stroke risk at 2 days. INTERPRETATION The reported early risks of stroke after TIA were highly heterogeneous, but this could be largely accounted for by differences in study method, setting, and treatment, with lowest risks in studies of emergency treatment in specialist stroke services.
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Affiliation(s)
- Matthew F Giles
- Stroke Prevention Research Unit, Oxford University Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK.
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Durán Ferreras E, Viguera Romero J, Martínez Parra C. [Transient ischemic attack]. Rev Clin Esp 2007; 207:505-7. [PMID: 17988597 DOI: 10.1157/13111549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
During recent years a new definition for transient ischemic attack (TIA) has been proposed. This has been based on the advances in neuroimaging techniques and because it has been observed that most TIA last only a few minutes. Brain damage must be ruled out and TIA duration can be no longer than one hour. TIA increases the chance of stroke or vascular episodes, above all during the first days and of other vascular diseases such as ischemic heart disease. It is a prevalent condition which must be considered as an emergency even though the patient is usually asymptomatic. For the initial evaluation, routine blood test, electrocardiogram, chest X-ray, brain computed tomography and extra and intracranial ultrasonography study must be performed. Treatment is based on the control of risk factors and antithrombotic therapy.
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Affiliation(s)
- E Durán Ferreras
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, Spain.
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Purroy F, Molina CA, Montaner J, Alvarez-Sabín J. Absence of Usefulness of ABCD Score in the Early Risk of Stroke of Transient Ischemic Attack Patients. Stroke 2007; 38:855-6; author reply 857. [PMID: 17234986 DOI: 10.1161/01.str.0000257306.00512.d3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Purroy García F, Molina Cateriano CA, Montaner Villalonga J, Delgado Martínez P, Santmarina Pérez E, Toledo M, Quintana M, Alvarez Sabín J. Ausencia de utilidad de la escala clínica ABCD en el riesgo de infarto cerebral precoz en pacientes con accidente isquémico transitorio. Med Clin (Barc) 2007; 128:201-3. [PMID: 17335722 DOI: 10.1157/13098716] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND OBJECTIVE Recently a clinical score (ABCD) to identify individuals at high seven-day risk of stroke after transient ischemic attack (TIA) was proposed. The aim of this study was to test this clinical model. PATIENTS AND METHOD We validated the ABCD score (age > or = 65 years = 1; hypertension = 1; unilateral weakness = 2, speech disturbance without weakness = 1, duration of symptoms in minutes > or = 60 = 2; 10-59 = 1; < 10 = 0) in 325 consecutive TIA patients. Clinical data, symptoms duration, CT scan, and ultrasonographic (carotid and transcranial) findings were collected. Seven-day risk of stroke was recorded. RESULTS A total of 16 (4.9%) patients had a stroke recurrence within the first seven days after symptoms onset. Six out of 16 (37.5%) strokes occurred in 115 (35.4%) patients with a score of 5 or greater, while the 7-day risk was 4.8% (95% CI 2.04-7.56) in 210 (63.5%) patients with a score less than 5. In cox proportional hazards multivariate analyses only large-artery occlusive disease remained an independent predictor of stroke recurrence [hazard ratio = 5.66 (95% CI 2.06-15.57; p = 0.001)]. CONCLUSIONS Clinical data are not enough to identify patients at higher risk. The combination of clinical, radiological and vascular information may improve the predictive accuracy of stroke recurrence risk. The routine use of combined carotid/transcranial ultrasound testing performed early will be useful for identifying high risk individuals in order to plan urgent aggressive prevention therapies.
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