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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. Long-Term Stroke Recurrence after Transient Ischemic Attack: Implications of Etiology. J Stroke 2019; 21:184-189. [PMID: 30991798 PMCID: PMC6549066 DOI: 10.5853/jos.2018.03601] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 02/18/2019] [Indexed: 11/11/2022] Open
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 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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Affiliation(s)
- Angel Ois
- Department of Neurology, Hospital del Mar, Barcelona, Spain.,Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain
| | - Elisa Cuadrado-Godia
- Department of Neurology, Hospital del Mar, Barcelona, Spain.,Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain
| | - Eva Giralt-Steinhauer
- Department of Neurology, Hospital del Mar, Barcelona, Spain.,Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain
| | - Jordi Jimenez-Conde
- Department of Neurology, Hospital del Mar, Barcelona, Spain.,Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain
| | - Carolina Soriano-Tarraga
- Department of Neurology, Hospital del Mar, Barcelona, Spain.,Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain
| | - Ana Rodríguez-Campello
- Department of Neurology, Hospital del Mar, Barcelona, Spain.,Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain
| | - Carla Avellaneda
- Department of Neurology, Hospital del Mar, Barcelona, Spain.,Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain
| | - Diego Cascales
- Department of Neurology, Hospital del Mar, Barcelona, Spain
| | | | - Jaume Roquer
- Department of Neurology, Hospital del Mar, Barcelona, Spain.,Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain
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