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How predictors and patterns of stroke recurrence after a TIA differ during the first year of follow-up

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Abstract

The highest risk of subsequent stroke after a TIA occurs within the first week after the index event. However, the risk of stroke recurrence (SR) remains high during the first year of follow-up. We studied the temporal pattern and predictors of SR (at 7 days and from 7 days to 1-year follow-up). Between April 2008 and December 2009, we included 1,255 consecutive TIA patients from 30 Spanish stroke centers (PROMAPA study). We determined the short-term (at 7 days) and long-term (from 8 days to 1 year) risk of SR. Patients who underwent short-term recurrence and long-term recurrence were compared with regard to clinical findings, vascular territories, and etiology. Enough information (clinical variables and extracranial vascular imaging) was assessed in 1,137 (90.6 %) patients. The 7-day stroke risk was 2.6 %. 32 (3.0 %) patients had an SR after 7-day follow-up. Multiple TIA (HR 3.50, 1.67–7.35, p = 0.001) and large artery atherosclerosis (HR 2.51, 1.17–5.37, p = 0.018) were independent predictors of early SR, whereas previous stroke (HR 1.40, 1.03–1.92, p = 0.034) and coronary heart disease (2.65, 1.28–5.50, p = 0.009) were independent predictors of late SR. Notoriously, 80 % of SR happened in the same territory of the index TIA at 7-day follow-up, whereas only 38 % during the long-term follow-up (p < 0.001). Different predictors of SR were identified throughout the follow-up period. Moreover, the ischemic mechanism differed in early and late stroke recurrences.

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Reference

  1. Special report from the National Institute of Neurological Disorders and Stroke (1990) Classification of cerebrovascular diseases III. Stroke 21:637–676

    Article  Google Scholar 

  2. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE 3rd (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke 24:35–41

    Article  PubMed  Google Scholar 

  3. Amarenco P, Cohen A, Tzourio C, Bertrand B, Hommel M, Besson G, Chauvel C, Touboul P-J, Bousser M-G (1994) Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. N Engl J Med 331:1474–1479

    Article  CAS  PubMed  Google Scholar 

  4. Atanassova PA, Chalakova NT, Dimitrov BD (2008) Major vascular events after transient ischaemic attack and minor ischaemic stroke: post hoc modelling of incidence dynamics. Cerebrovasc Dis 25:225–233

    Article  PubMed  Google Scholar 

  5. Ay H, Furie KL, Singhal A, Smith WS, Sorensen AG, Koroshetz WJ (2005) An evidence-based causative classification system for acute ischemic stroke. Ann Neurol 58:688–697

    Article  PubMed  Google Scholar 

  6. Bang OY, Ovbiagele B, Kim JS (2014) Evaluation of cryptogenic stroke with advanced diagnostic techniques. Stroke 45:1186–1194

    Article  PubMed  Google Scholar 

  7. Correia M, Silva MR, Magalhaes R, Guimaraes L, Silva MC (2006) Transient ischemic attacks in rural and urban northern Portugal: incidence and short-term prognosis. Stroke 37:50–55

    Article  PubMed  Google Scholar 

  8. Chatzikonstantinou A, Willmann O, Jager T, Szabo K, Hennerici MG (2009) Transient ischemic attack patients with fluctuations are at highest risk for early stroke. Cerebrovasc Dis 27:594–598

    Article  PubMed  Google Scholar 

  9. Giles MF, Rothwell PM (2007) Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol 6:1063–1072

    Article  PubMed  Google Scholar 

  10. Guidoux C, Mazighi M, Lavallee P, Labreuche J, Meseguer E, Cabrejo L, Messika-Zeitoun D, Escoubet B, Touboul PJ, Steg PG, Amarenco P (2013) Aortic arch atheroma in transient ischemic attack patients. Atherosclerosis 231:124–128

    Article  CAS  PubMed  Google Scholar 

  11. Hatano S (1976) Experience from a multicentre stroke register: a preliminary report. Bull World Health Organ 54:541–553

    PubMed Central  CAS  PubMed  Google Scholar 

  12. Hill MD, Yiannakoulias N, Jeerakathil T, Tu JV, Svenson LW, Schopflocher DP (2004) The high risk of stroke immediately after transient ischemic attack: a population-based study. Neurology 62:2015–2020

    Article  CAS  PubMed  Google Scholar 

  13. Hoshino T, Nagao T, Mizuno S, Shimizu S, Uchiyama S (2013) Cardioembolic stroke is frequent in late recurrence after transient ischemic attack. J Stroke Cerebrovasc Dis 22:822–827

    Article  PubMed  Google Scholar 

  14. Ibrahimi P, Jashari F, Nicoll R, Bajraktari G, Wester P, Henein MY (2013) Coronary and carotid atherosclerosis: how useful is the imaging? Atherosclerosis 231:323–333

    Article  CAS  PubMed  Google Scholar 

  15. Johnston SC, Gress DR, Browner WS, Sidney S (2000) Short-term prognosis after emergency department diagnosis of TIA. JAMA 284:2901–2906

    Article  CAS  PubMed  Google Scholar 

  16. Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, Sidney S (2007) Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet 369:283–292

    Article  PubMed  Google Scholar 

  17. Lavallee PC, Meseguer E, Abboud H, Cabrejo L, Olivot J-M, Simon O, Mazighi M, Nifle C, Niclot P, Lapergue B, Klein IF, Brochet E, Steg PG, Leseche G, Labreuche J, Touboul P-J, Amarenco P (2007) A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects. Lancet Neurol 6:953–960

    Article  CAS  PubMed  Google Scholar 

  18. Lisabeth LD, Ireland JK, Risser JM, Brown DL, Smith MA, Garcia NM, Morgenstern LB (2004) Stroke risk after transient ischemic attack in a population-based setting. Stroke 35:1842–1846

    Article  PubMed  Google Scholar 

  19. Luengo-Fernandez R, Gray AM, Rothwell PM (2009) Effect of urgent treatment for transient ischaemic attack and minor stroke on disability and hospital costs (EXPRESS study): a prospective population-based sequential comparison. Lancet Neurol 8:235–243

    Article  PubMed  Google Scholar 

  20. Merwick A, Albers GW, Amarenco P, Arsava EM, Ay H, Calvet D, Coutts SB, Cucchiara BL, Demchuk AM, Furie KL, Giles MF, Labreuche J, Lavallee PC, Mas JL, Olivot JM, Purroy F, Rothwell PM, Saver JL, Sheehan OC, Stack JP, Walsh C, Kelly PJ (2010) Addition of brain and carotid imaging to the ABCD(2) score to identify patients at early risk of stroke after transient ischaemic attack: a multicentre observational study. Lancet Neurol 9:1060–1069

    Article  PubMed  Google Scholar 

  21. Morris JG, Duffis EJ, Fisher M (2009) Cardiac workup of ischemic stroke: can we improve our diagnostic yield? Stroke 40:2893–2898

    Article  PubMed  Google Scholar 

  22. Norrving B (2003) Long-term prognosis after lacunar infarction. Lancet Neurol 2:238–245

    Article  PubMed  Google Scholar 

  23. Ois A, Gomis M, Rodriguez-Campello A, Cuadrado-Godia E, Jimenez-Conde J, Pont-Sunyer C, Cuccurella G, Roquer J (2008) Factors associated with a high risk of recurrence in patients with transient ischemic attack or minor stroke. Stroke 39:1717–1721

    Article  PubMed  Google Scholar 

  24. Purroy F, Begue R, Quilez A, Pinol-Ripoll G, Sanahuja J, Brieva L, Seto E, Gil MI (2009) Diagnostic lessons of recurrence pattern after transient ischemic attacks. Med Clin (Barc) 133:283–289

    Article  Google Scholar 

  25. Purroy F, Jimenez Caballero PE, Gorospe A, Torres MJ, Alvarez-Sabin J, Santamarina E, Martinez-Sanchez P, Canovas D, Freijo MJ, Egido JA, Ramirez-Moreno JM, Alonso-Arias A, Rodriguez-Campello A, Casado I, Delgado-Mederos R, Marti-Fabregas J, Fuentes B, Silva Y, Quesada H, Cardona P, Morales A, de la Ossa NP, Garcia-Pastor A, Arenillas JF, Segura T, Jimenez C, Masjuan J, Stroke Project of the Spanish Cerebrovascular Diseases Study G (2013) Recurrent transient ischaemic attack and early risk of stroke: data from the PROMAPA study. J Neurol Neurosurg Psychiatry 84:596–603

    Article  PubMed  Google Scholar 

  26. Purroy F, Jiménez-Caballero PE, Gorospe A, Torres MJ, Álvarez-Sabín J, Santamarina E, Martínez-Sánchez P, Cánovas D, Freijó MM, Egido JA, Girón JM, Ramírez-Moreno JM, Alonso A, Rodríguez-Campello A, Casado I, Delgado-Mederos R, Marti-Fabregas J, Fuentes B, Silva Y, Quesada H, Cardona P, Morales A, de la Ossa NP, García Pastor A, Arenillas JF, Segura T, Jiménez C, Masjuán J (2012) Prediction of early stroke recurrence in TIA patients from the PROMAPA study. A comparison of prognostic risk scores. Cerebrovasc Dis 33:182–189

    Article  CAS  PubMed  Google Scholar 

  27. Purroy F, Montaner J, Molina CA, Delgado P, Ribo M, Alvarez-Sabin J (2007) Patterns and predictors of early risk of recurrence after transient ischemic attack with respect to etiologic subtypes. Stroke 38:3225–3229

    Article  PubMed  Google Scholar 

  28. Rothwell PM, Giles MF, Chandratheva A, Marquardt L, Geraghty O, Redgrave JN, Lovelock CE, Binney LE, Bull LM, Cuthbertson FC, Welch SJ, Bosch S, Carasco-Alexander F, Silver LE, Gutnikov SA, Mehta Z (2007) Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet 370:1432–1442

    Article  PubMed  Google Scholar 

  29. Rothwell PM, Warlow CP (2005) Timing of TIAs preceding stroke: time window for prevention is very short. Neurology 64:817–820

    Article  PubMed  Google Scholar 

  30. van Wijk I, Kappelle LJ, van Gijn J, Koudstaal PJ, Franke CL, Vermeulen M, Gorter JW, Algra A (2005) Long-term survival and vascular event risk after transient ischaemic attack or minor ischaemic stroke: a cohort study. Lancet 365:2098–2104

    Article  PubMed  Google Scholar 

  31. Weimar C, Benemann J, Huber R, Mieck T, Kaendler S, Grieshammer S, Katsarava Z, Diener HC (2009) Long-term mortality and risk of stroke after transient ischemic attack: a hospital-based cohort study. J Neurol 256:639–644

    Article  PubMed  Google Scholar 

  32. Wu CM, McLaughlin K, Lorenzetti DL, Hill MD, Manns BJ, Ghali WA (2007) Early risk of stroke after transient ischemic attack: a systematic review and meta-analysis. Arch Intern Med 167:2417–2422

    Article  PubMed  Google Scholar 

  33. Zhang Y, Chapman AM, Plested M, Jackson D, Purroy F (2012) The incidence, prevalence, and mortality of stroke in France, Germany, Italy, Spain, the UK, and the US: a literature review. Stroke Res Treat 2012:436125

    PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by Sanofi-Aventis.

Conflicts of interest

Dr. J. Masjuán serves on the scientific advisory board for Boehringer Ingelheim.

Dr. J.A. Egido serves on the scientific advisory board for Boehringer Ingelheim.

Ethical standard

The study was approved by the ethics committee of the Arnau de Vilanova University Hospital and all the institutions involved in the study. Written informed consent was obtained from all study participants.

Author information

Authors and Affiliations

  1. Stroke Unit, Department of Neurology, IRBLLEIDA Research Institute, Hospital Universitari Arnau de Vilanova de Lleida, Universitat de Lleida, Avda Rovira Roure, 80, 25198, Lleida, Spain

    F. Purroy

  2. Department of Neurology, Hospital San Pedro de Alcántara de Cáceres, Cáceres, Spain

    P. E. Jiménez Caballero & I. Casado-Naranjo

  3. Department of Neurology, Hospital Universitario Son Espases, Palma de Mallorca, Spain

    A. Gorospe, M. J. Torres & C. Jiménez

  4. Stroke Unit, Department of Neurology, Hospital Universitari Valld’Hebron, Barcelona, Spain

    J. Álvarez-Sabin

  5. Stroke Centre, Department of Neurology, IdiPAZ Research Institute, La Paz University Hospital, Autónoma de Madrid University, Madrid, Spain

    P. Martínez-Sánchez

  6. Department of Neurology, Hospital Parc Taulí, Sabadell, Spain

    D. Cánovas

  7. Department of Neurology, Hospital de Basurto, Bilbao, Spain

    M. Freijo

  8. Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain

    J. A. Egido

  9. Department of Neurology, Hospital Universitario Infanta Cristina, Badajoz, Spain

    J. M. Ramírez-Moreno

  10. Stroke Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain

    A. Alonso-Arias & J. Masjuán

  11. Stroke Unit, Hospital del Mar, Barcelona, Spain

    A. Rodríguez-Campello

  12. Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

    J. Martí-Fàbregas

  13. Stroke Unit, Hospital Universari Josep Trueta, Girona, Spain

    Y. Silva

  14. Stroke Unit, Department of Neurology, Hospital Universitari de Bellvitge, Hospital de Llobregat, Barcelona, Spain

    P. Cardona

  15. Department of Neurology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain

    A. Morales

  16. Stroke Unit, Neurology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    A. García-Pastor

  17. Stroke Unit & Stroke Program, Department of Neurology, Universitary Hospital, University of Valladolid, Valladolid, Spain

    J. F. Arenillas

  18. Department of Neurology, Hospital Universitario de Albacete, Albacete, Spain

    T. Segura

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  1. F. Purroy
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  2. P. E. Jiménez Caballero
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  15. Y. Silva
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  20. T. Segura
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  21. C. Jiménez
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  22. J. Masjuán
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Corresponding author

Correspondence to F. Purroy.

Additional information

On behalf of the Stroke Project of the Spanish Cerebrovascular Diseases Study Group.

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Purroy, F., Jiménez Caballero, P.E., Gorospe, A. et al. How predictors and patterns of stroke recurrence after a TIA differ during the first year of follow-up. J Neurol 261, 1614–1621 (2014). https://doi.org/10.1007/s00415-014-7390-z

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  • DOI: https://doi.org/10.1007/s00415-014-7390-z

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