Transient Ischaemic Attack Rarely Precedes Stroke in a Cohort with Low Proportions of Large Artery Atherosclerosis: A Population-Based Study

Autor: Sally Castle, Jonathan Newbury, James Leyden, Timothy Kleinig, Blake F Giarola, Jim Jannes, Craig S. Anderson
Jazyk: angličtina
Rok vydání: 2018
Předmět:
medicine.medical_specialty
lcsh:Diseases of the circulatory (Cardiovascular) system
Time Factors
Transient ischaemic attack
Arteriosclerosis
Population
03 medical and health sciences
0302 clinical medicine
Risk Factors
Adelaide Stroke Incidence Study
Internal medicine
Ischaemic stroke
South Australia
ABCD2
Medicine
Humans
030212 general & internal medicine
Prospective Studies
cardiovascular diseases
education
Stroke
education.field_of_study
Original Paper
biology
business.industry
Incidence
Large artery
medicine.disease
Confidence interval
Plaque
Atherosclerotic
3. Good health
nervous system diseases
Population based study
Neurology
Ischemic Attack
Transient
lcsh:RC666-701
Cohort
Cardiology
biology.protein
Large artery atherosclerosis
Neurology (clinical)
Cardiology and Cardiovascular Medicine
business
030217 neurology & neurosurgery
Zdroj: Cerebrovascular Diseases Extra, Vol 8, Iss 2, Pp 101-105 (2018)
Cerebrovascular Diseases Extra
ISSN: 1664-5456
Popis: Background: Ischaemic stroke is reportedly preceded by transient ischaemic attack (TIA) in 15–30% of all cases. The risk of stroke following TIA is highest in the presence of unstable atherosclerotic plaques in large arteries. The recent population-based Adelaide Stroke Incidence Study describes a population with a low proportion (16%) of stroke attributable to large artery atherosclerosis (LAA). We hypothesized that this population-based ischaemic stroke cohort would have a lower rate of preceding TIA than previously reported. Methods: This paper is a prospective ascertainment of all suspected TIAs and strokes in a 12-month period from 2009 to 2010. Ischaemic stroke pathogenesis was classified by the TOAST criteria. Details of preceding TIA events were scrutinised. Results: In this 12-month period, 318 stroke events in 301 individuals were recorded. Of the total 258 ischaemic strokes, 16% (95% confidence interval [CI] 12–22) were from LAA. Of 258 ischaemic stroke patients, only 11 (4%; 95% CI 2–7) reported symptoms in the preceding 90 days consistent with TIA. Nine (82%) sought medical attention. The median ABCD2 score in this group was 4.5 (IQR: 3–7), and the median time of event prior to stroke was 20 days (IQR: 4–32). Conclusion: In our population-based cohort, rates of TIA preceding ischaemic stroke were much lower than previously reported, probably reflective of effective secondary prevention (active TIA clinics) and primary prevention (limiting LAA prevalence). In our population, further enhancements in TIA care will be of limited yield.
Databáze: OpenAIRE
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