Transient brain ischemic symptoms and the presence of ischemic lesions at neuroimaging: Results from the READAPT study.

Autor:	Ornello R; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy., Foschi M; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy., De Santis F; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy., Romoli M; Department of Neuroscience, Maurizio Bufalini Hospital, AUSL Romagna, Cesena, Italy., Tassinari T; Department of Neurology, Santa Corona Hospital, Pietra Ligure, Italy., Saia V; Department of Neurology, Santa Corona Hospital, Pietra Ligure, Italy., Cenciarelli S; Department of Neurology, Città di Castello Hospital, Città di Castello, Italy., Bedetti C; Department of Neurology, Città di Castello Hospital, Città di Castello, Italy., Padiglioni C; Department of Neurology, Città di Castello Hospital, Città di Castello, Italy., Censori B; Department of Neurology, ASST Cremona Hospital, Cremona, Italy., Puglisi V; Department of Neurology, ASST Cremona Hospital, Cremona, Italy., Vinciguerra L; Department of Neurology, ASST Cremona Hospital, Cremona, Italy., Guarino M; IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology, Policlinico S. Orsola-Malpighi, Bologna, Italy., Barone V; IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology, Policlinico S. Orsola-Malpighi, Bologna, Italy., Zedde ML; Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy., Grisendi I; Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy., Diomedi M; Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy., Bagnato MR; Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy., Petruzzellis M; Department of Neurology and Stroke Unit, 'F. Puca' AOU Consorziale Policlinico, Bari, Italy., Mezzapesa DM; Department of Neurology and Stroke Unit, 'F. Puca' AOU Consorziale Policlinico, Bari, Italy., Di Viesti P; Department of Neurology, Fondazione IRCCS Casa sollievo della sofferenza, San Giovanni Rotondo, Italy., Inchingolo V; Department of Neurology, Fondazione IRCCS Casa sollievo della sofferenza, San Giovanni Rotondo, Italy., Cappellari M; Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy., Zenorini M; Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy., Candelaresi P; Department of Neurology and Stroke Unit, AORN Antonio Cardarelli, Naples, Italy., Andreone V; Department of Neurology and Stroke Unit, AORN Antonio Cardarelli, Naples, Italy., Rinaldi G; Department of Neurology, Di Venere Hospital, Bari, Italy., Bavaro A; Department of Neurology, Di Venere Hospital, Bari, Italy., Cavallini A; UO Neurologia d'Urgenza e Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy., Moraru S; UO Neurologia d'Urgenza e Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy., Querzani P; Department of Neuroscience, S. Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy., Terruso V; Department of Neurology, AOOR Villa Sofia-Cervello, Palermo, Italy., Mannino M; Department of Neurology, AOOR Villa Sofia-Cervello, Palermo, Italy., Scoditti U; Department of Emergency-Neurology-Stroke Care, University Hospital of Parma, Parma, Italy., Pezzini A; Department of Medicine and Surgery, University of Parma, Parma, Italy., Frisullo G; Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy., Muscia F; Department of Neurology, ASST-Ovest Milanese, Legnano, Italy., Paciaroni M; Stroke Unit, Department of Internal and Cardiovascular Medicine, University Hospital Santa Maria della Misericordia, Perugia, Italy., Mosconi MG; Stroke Unit, Department of Internal and Cardiovascular Medicine, University Hospital Santa Maria della Misericordia, Perugia, Italy., Zini A; IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy., Leone R; Department of Neurology and Stroke Unit, 'M. R. Dimiccoli' Hospital, Barletta, Italy., Palmieri C; Stroke Unit-S.C. Neurologia-ASL TO3 P.O. Pinerolo Ospedale 'E. Agnelli,' Pinerolo, Italy., Cupini LM; Department of Neurology and Stroke Unit, S. Eugenio Hospital, Rome, Italy., Marcon M; Department of Neurology, Cazzavillan Hospital Arzignano, Vicenza, Italy., Tassi R; Stroke Unit, Urgency and Emergency Department, Azienda Ospedaliera Universitaria Senese, Siena, Italy., Sanzaro E; Department of Neurology, Umberto I Hospital, Siracusa, Italy., Paci C; UOC Neurologia, Ospedale 'Madonna del Soccorso,' San Benedetto del Tronto, Italy., Viticchi G; Experimental and Clinical Medicine Department, Marche Polytechnic University, Ancona, Italy., Orsucci D; Unit of Neurology-San Luca Hospital, Lucca and Castelnuovo Garfagnana, Italy., Falcou A; Department of Human Neurosciences, Interventional Neuroradiology and Neurology, University of Rome La Sapienza, Roma, Italy., Diamanti S; Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori Monza, Monza, Italy., Tarletti R; SCDU Neurologia-Stroke Unit, Azienda Ospedaliero-Universitaria 'Maggiore della Carità,' Novara, Italy., Nencini P; Stroke Unit, Careggi University Hospital, Florence, Italy., Rota E; Department of Neurology, San Giacomo Hospital, Novi Ligure, Italy., Sepe FN; Stroke Unit, Department of Neurology, SS. Biagio e Arrigo, Alessandria, Italy., Ferrandi D; Stroke Unit, Department of Neurology, SS. Biagio e Arrigo, Alessandria, Italy., Caputi L; Department of Cardiocerebrovascular Diseases, Neurology-Stroke Unit-ASST Ospedale Maggiore di Crema, Crema, Italy., Volpi G; Department of Neurology, San Jacopo Hospital, Pistoia, Italy., La Spada S; Department of Neurology, Antonio Perrino Hospital, Brindisi, Italy., Beccia M; Department of Neurology, Sant'Andrea Hospital, Rome, Italy., Rinaldi C; Neurology Unit, 'Infermi' Hospital, AUSL Romagna, Rimini, Italy., Mastrangelo V; Neurology Unit, 'Infermi' Hospital, AUSL Romagna, Rimini, Italy., Di Blasio F; Stroke Unit, 'S. Spirito' Hospital, Pescara, Italy., Invernizzi P; Departiment of Neurology, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy., Pelliccioni G; Department of Neurology IRCCS-INRCA, Ancona, Italy., De Angelis MV; Stroke Unit, 'S. Spirito' Hospital, Pescara, Italy.; Department of Neurology and Stroke Unit, SS Annunziata Hospital, Chieti, Italy., Bonanni L; Dipartimento di Medicina e Scienze dell'Invecchiamento, Università G. d'Annunzio di Chieti-Pescara e Clinica Neurologica e Stroke Unit Ospedale Clinicizzato SS. Annunziata di Chieti, Chieti, Italy., Ruzza G; Department of Neurology, Civil Hospital, Cittadella, Italy., Caggia EA; Neurology Unit, Cardio-Neuro-Vascular Department, Giovanni Paolo II Hospital, Ragusa, Italy., Russo M; Department of Neurology, St Misericordia Hospital, Rovigo, Italy., Tonon A; Department of Neurology, Ospedale Civile Ss. Giovanni e Paolo, Venezia, Italy., Acciarri MC; Department of Neurology, A. Murri Fermo Hospital, Fermo, Italy., Anticoli S; Stroke Unit, Azienda Ospedaliera San Camillo, Rome, Italy., Roberti C; Department of Neurology, San Filippo Neri Hospital, Rome, Italy., Manobianca G; Department of Neurology, General Regional Hospital 'F. Miulli,' Acquaviva delle Fonti, Italy., Scaglione G; Department of Neurology, General Regional Hospital 'F. Miulli,' Acquaviva delle Fonti, Italy., Pistoia F; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy., Fortini A; Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy., De Boni A; Department of Neuroscience, San Bortolo Hospital, Vicenza, Italy., Sanna A; Stroke Unit, AOU Sassari, Sassari, Italy., Chiti A; Unit of Neurology, Apuane Hospital, Massa Carrara, Italy., Barbarini L; Department of Neurology, Vito Fazi Hospital, Lecce, Italy., Masato M; Department of Neurology, Mirano Hospital, Mirano, Italy., Del Sette M; Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Passarelli F; Department of Neurology, Fatebenefratelli Hospital, Rome, Italy., Bongioanni MR; Department of Neurology, SS Annunziata Hospital, Savigliano, Italy., Toni D; Department of Human neurosciences, University of Rome La Sapienza, Rome, Italy., Ricci S; Department of Neurology, Città di Castello Hospital, Città di Castello, Italy.; Coordinatore Comitato Scientifico ISA-AII, Città di Castello, Italy., Sacco S; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy., De Matteis E; Department of Brain Sciences, Imperial College London, London, UK.
Jazyk:	angličtina
Zdroj:	International journal of stroke : official journal of the International Stroke Society [Int J Stroke] 2024 Dec 16, pp. 17474930241302691. Date of Electronic Publication: 2024 Dec 16.
DOI:	10.1177/17474930241302691
Abstrakt:	Background: According to the literature, about one third of patients with brain ischemic symptoms lasting <24 h, which are classified as Transient ischemic attacks (TIAs) according to the traditional "time-based" definition, show the presence of acute ischemic lesions at neuroimaging. Recent evidence has shown that the presence of acute ischemic lesions at neuroimaging may impact on the outcome of patients with transient ischemic symptoms treated with dual antiplatelet treatment (DAPT). This uncertainty is even more compelling in recent years as short-term DAPT has become the standard treatment for any non-cardioembolic TIA or minor ischemic stroke. Methods: This is a pre-specified subgroup analysis from a prospective multicenter real-world study (READAPT). The analysis included patients with time-based TIA-that is, those with ischemic symptoms lasting <24 h-who started DAPT. In the whole population, we assessed the presence of acute brain ischemic lesions at neuroimaging and their association with the ABCD 2 score. To assess the impact of acute brain ischemic lesions on 90-day prognosis, we performed a propensity score matching of patients with and without those lesions. We adopted a primary effectiveness outcome which was a composite of new stroke/TIA events and death due to vascular causes at 90 days. Results: We included 517 patients-324 (62.7%) male-with a median (interquartile range-IQR) age of 74 (IQR = 65-81) years; 144 patients (27.9%) had acute brain ischemic lesions at neuroimaging. The proportion of patients with brain ischemic lesions did not vary according to the ABCD 2 score. At follow-up, 4 patients with brain ischemic lesions (2.8%) and 21 patients without lesions (5.6%) reported the primary effectiveness outcome, which was similar between the groups before ( p  = 0.178) and after matching ( p  = 0.518). Conclusions: In our population, patients with transient ischemic symptoms and acute ischemic lesions at brain magnetic resonance imaging (MRI) had a risk of recurrent ischemic events similar to those without lesions. The risk of recurrent ischemic events was low in both groups. Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: A.Z. reports compensation from Angels Initiative, Boehringer-Ingelheim, and Daiichi Sankyo for consultant services; from Angels Initiative, Boehringer-Ingelheim, and CSL Behring for speaking honoraria or other education services; from Daiichi Sankyo for meeting; from Bayer and Astra Zeneca for participation on a Data Safety, Monitoring Board or Advisory Board; and he is member of ESO guidelines, ISA-AII guidelines, and IRETAS steering committee. R.O. reports grants from Novartis and Allergan; compensation from Teva Pharmaceutical Industries, Eli Lilly and Company, and Novartis for other services; and travel support from Teva Pharmaceutical Industries. S.S. reports compensation from Novartis, NovoNordisk, Allergan, AstraZeneca, Pfizer Canada, Inc., Eli Lilly and Company, Teva Pharmaceutical Industries, H. Lundbeck A/S, and Abbott Canada for consultant services; employment by Università degli Studi dell’Aquila; and compensation from Novartis for other services. MP reports compensation from Daiichi Sankyo Company, Bristol Myers Squibb, Bayer, and Pfizer Canada, Inc., for consultant services. DT reports compensation from Alexion, Astra Zeneca, Medtronic, and Pfizer for consultant services and participation on a Data Safety, Monitoring Board or Advisory Board. The other authors report no conflicts.
Databáze:	MEDLINE
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