Abstract T P292: Baseline Infarct Volume Predicts Disability in TIA and Minor Stroke Patients

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Negar Asdaghi ◽  
jonathan Coulter ◽  
Jayish Modi ◽  
Abdul Qazi ◽  
Mayank Goyal ◽  
...  
Keyword(s):  
Tissue Injury ◽  
Infarct Volume ◽  
Recurrent Stroke ◽  
Multivariable Analysis ◽  
National Institutes Of Health ◽  
Minor Stroke ◽  
Predicting Outcome ◽  
Ischemic Attack ◽  
Symptom Progression ◽  
The Impact

BACKGROUND: Despite their mild presenting neurological deficit, over one third of patients with transient ischemic attack (TIA) and minor stroke are dead or disabled at the time of hospital discharge. This is predominantly related to either symptom progression or recurrent stroke, although predicting outcome can be difficult. We sought to determine whether baseline radiographic MR characteristics could predict disability at 3months in this population. METHODS: Consecutive TIA/minor stroke (National Institutes of Health Stroke Scale<4) that were not disabled at baseline and had an MRI within 24 hours of symptom onset were prospectively included. Disability was assessed at 90 days using the modified Rankin Scale (mRS). The impact of perfusion (PWI) and diffusion (DWI) variables on disability (mRS≥2) at 90 days was assessed. RESULTS: 418 patients were included; 55.5% had positive DWI lesions. 292 patients had PWI imaging of whom 35% had PWI deficit (Tmax≥2s) and 26.5% had mismatch (Tmax≥4s-DWI) at baseline. The median DWI, PWI and mismatch volumes were 1.14 ml (IQR=3.43), 9.8 ml (IQR=29.8) and 9 ml respectively. A total of 56/418 (13.4%) patients were disabled at 90days. In multivariable analysis we adjusted for baseline predictors of disability (age, DM, premorbid mRS 1, ongoing symptoms, baseline NIHSS, CT/CT angiography-positive metric and DWI or PWI volume). DWI volume (OR=1.05, p=0.007), and age (OR=1.03, p=0.003) remained independent predictors of disability. PWI or mismatch volume did not predict functional outcome. CONCLUSIONS: A substantial proportion of patients with TIA and minor stroke are disabled at 90days. The degree of tissue injury as measured by DWI volume is an independent predictor of disability regardless of the mechanism of disability.

scholarly journals Historic Stroke Motor Severity Score Predicts Progression in TIA/Minor Stroke

2014 ◽  
Vol 41 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Marie-Christine Camden ◽  
Michael D. Hill ◽  
Andrew M. Demchuk ◽  
Alexandre Y. Poppe ◽  
Nan Shobha ◽  
...  
Keyword(s):  
Severity Score ◽  
Recurrent Stroke ◽  
Minor Stroke ◽  
Motor Deficits ◽  
Stroke Severity ◽  
Early Improvement ◽  
Stroke Population ◽  
Early Neurological Deterioration ◽  
Ischemic Attack ◽  
Symptom Progression

Background:transient ischemic attack (tIA) and minor stroke have a high risk of early neurological deterioration, and patients who experience early improvement are at risk of deterioration. We generated a score for quantifying the worst reported motor and speech deficits and assessed whether this predicted outcome.Methods:510 tIA or minor stroke (NIHSS>4) patients were included. the Historical Stroke Severity Score (HSSS) prospectively quantified the patient's description of the worst motor or speech deficits. the HSSS was rated at the time of first assessment with more severe deficits scoring higher. Motor HSSS included assessments of arm and leg motor power (score total 0-5). Speech HSSS assessed severity of dysarthria and aphasia (total 0-3). the association between motor and speech HSSS and symptom progression was assessed during the 90-day follow-up period.Results:the proportion of patients in each category of the motor HSSS was 0: 43% (216/510), 1: 22%(110/510), 2: 17% (89/510), 3: 7% (37/510), 4: 5% (28/510) and 5: 6% (30/510). Motor HSSS was associated with symptom progression (p=0.004) but not recurrent stroke. Speech HSSS was not associated with either progression or recurrent stroke. Motor HSSS predicted disability (p=0.002) and intracranial occlusion (p=0.012). Disability increased with increasing motor HSSS.Conclusions:taking a detailed history about the severity of motor deficits, but not speech, predicted outcome in tIA and minor stroke patients. A score based on the patient's description of the severity of motor symptoms predicted symptom progression, intracranial occlusion and functional outcome, but not recurrent stroke in a tIA and minor stroke population.

Abstract WP56: Refinement of imaging predictors of recurrent events following Transient Ischemic Attack and Minor Stroke.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Myles Horton
Keyword(s):  
White Matter ◽  
Transient Ischemic Attack ◽  
Recurrent Events ◽  
Recurrent Stroke ◽  
Initial Assessment ◽  
Minor Stroke ◽  
White Matter Disease ◽  
Ischemic Attack ◽  
Symptom Progression ◽  
Prior Stroke

Background: Transient ischemic attack (TIA) and minor stroke have a high risk of recurrent stroke. We recently showed in the CATCH study that predefined radiographic abnormalities on CT/CTA and MRI predicted recurrent events after TIA and minor stroke. Specifically, the study recognized the predictive value of CT/CTA abnormalities that were defined apriori: acute ischemia on CT, intracranial or extracranial occlusion or stenosis > 50% (the CT/CTA positive metric), and diffusion-weighted imaging positivity on MRI. Aims: To improve upon the CT, CTA, MRI and clinical parameters that predict recurrent events after TIA and minor stroke. Our secondary aim was to explore predictors of stroke progression versus recurrence. Methods: 510 consecutive TIA and minor stroke patients (NIHSS score of <4) had CT/CTA and most had MRI. Primary outcome was recurrent events (combined outcome of stroke progression or distinct recurrent stroke) within 90 days. Imaging parameters not included in the original CATCH imaging (CT/CTA and MRI) metrics were assessed for prediction of recurrent events. We also completed an exploratory analysis comparing predictors of symptom progression versus recurrence. Results: There were 36 recurrent events (36/510, 7.1% (95%CI: 5.0-9.6)) including 19 progression and 17 recurrent strokes. On CT/CTA: white matter disease, prior stroke, aortic arch focal plaque≥4mm, or intraluminal thrombus did not predict recurrent events. On MRI: white matter disease, prior stroke, and microbleeds did not predict recurrent events. The only additional clinical predictor was symptom fluctuation (hazard ratio 2.3; 95% CI: 1.05-5.0). Parameters predicting symptom progression included: ongoing symptoms at initial assessment, symptom fluctuation, intracranial occlusion, intracranial occlusion or stenosis, and the CT/CTA metric. No parameter was strongly predictive of recurrent stroke. Conclusions: There was no imaging parameter that could improve upon our original CT/CTA or MRI metrics to predict recurrent events after TIA and minor stroke. Only the addition of symptom fluctuation to the CT/CTA metric improved the prediction of recurrent events. Imaging was more predictive of symptom progression than distinct recurrent events.

scholarly journals Comparison of outcome of patients with acute minor ischaemic stroke treated with intravenous t-PA, DAPT or aspirin

2020 ◽  
pp. svn-2019-000319
Author(s):  
Peng Wang ◽  
Mengyuan Zhou ◽  
Yuesong Pan ◽  
Xia Meng ◽  
Xingquan Zhao ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
National Institutes Of Health ◽  
Minor Stroke ◽  
Post Hoc Analysis ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
Ischemic Attack ◽  
Post Hoc

BackgroundWhether to treat minor stroke with intravenous tissue plasminogen activator (t-PA) treatment or antiplatelet therapy is a dilemma. Our study aimed to explore whether intravenous t-PA treatment, dual antiplatelet therapy (DAPT) and aspirin have different efficacies on outcomes in patients with minor stroke.MethodsA post hoc analysis of patients with acute minor stroke treated with intravenous t-PA within 4.5 hours from a nationwide multicentric electronic medical record and patients with acute minor stroke treated with DAPT and aspirin from the Clopidogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack Database. Minor stroke was defined by a score of 0–3 on the National Institutes of Health Stroke Scale at randomisation. Favourable functional outcome (defined as modified Rankin Scale (mRS) score of 0–1 or 0–2 at 3 months).ResultsCompared with those treated with intravenous t-PA, no significant association with 3-month favourable functional outcome (defined as mRS score of 0–1) was found neither in patients treated with aspirin (87.8% vs 89.4%; OR, 0.83; 95% CI, 0.46 to 1.50; p=0.53) nor those treated with DAPT (87.4% vs 89.4%; OR, 0.84; 95% CI, 0.46 to 1.52; p=0.56). Similar results were observed for the favourable functional outcome defined as mRS score of 0–2 at 3 months.ConclusionsIn our study, no significant advantage of intravenous t-PA over DAPT or aspirin was found. Due to insufficient sample size, our study is probably unable to draw such a conclusion that that intravenous t-PA was superior or non-superior to DAPT.

Abstract WP366: Exploring the Association Between Physician Trust and Recurrent Stroke and Transient Ischemic Attack (TIA)

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Anita Venkatesan ◽  
Bernadette Boden-Albala ◽  
Nina Parikh ◽  
Emily Goldmann
Keyword(s):  
Sex Education ◽  
Medication Compliance ◽  
Recurrent Stroke ◽  
Controlled Trial ◽  
National Study ◽  
Stroke Severity ◽  
Positive Health ◽  
Physician Trust ◽  
Ischemic Attack ◽  
The Impact

Purpose: More positive health behaviors, fewer symptoms, higher quality of life, and greater treatment satisfaction have been reported among those with greater physician trust. This study assessed the relationship between physician trust and recurrent stroke/TIA within 1 year of discharge among stroke survivors in Northern Manhattan. Methods: This study used data from the Stroke Warning Information and Faster Treatment (SWIFT) study, a randomized controlled trial conducted from 2005-2012 in a multiethnic cohort of 1,193 mild/moderate ischemic stroke and TIA survivors. The goal was to assess the impact of a stroke preparedness educational intervention on emergency department arrival time after subsequent stroke symptom onset. Physician trust, assessed at baseline, was measured with one item: “What percentage of the time do you trust doctors?”. For the analysis, it was dichotomized with the cutoff at 80%. Recurrent stroke/TIA was assessed at 1 month and 1 year. The association between recurrent stroke/TIA and patient trust was evaluated using multivariate logistic regression adjusted for sociodemographics and comorbidities. Results: In the analytic sample (n=1108), those who answered both exposure and outcome, the prevalence of recurrent stroke/TIA and lack of physician trust was 10.75% and 36.46%, respectively. Consistent with the literature, Hispanics compared to whites had a higher prevalence of lack of physician trust (42.71% vs. 34.11%, p<0.001). Adjusting for race/ethnicity, intervention status, age, sex, education, marital status, smoking, insurance, hypertension, diabetes, body mass index, physical activity, and depression, those who lacked trust had greater odds of recurrent stroke/TIA (OR=1.36, 95% CI:0.86-2.18) than those who had trust. When observing the association among Hispanics and Blacks, those who lacked trust had (OR=1.27, 95% CI: 0.66-2.42) and (OR=1.26, 95% CI: 0.36-4.38) respectively, greater odds of a recurrent episode than those who had trust. Conclusion: Despite insignificant findings, a national study with a greater range of stroke severity and additional measures such as medication compliance may be warranted to provide greater insight on the effects of physician trust on stroke outcomes.

Abstract 41: Prognostic Value of Perfusion MRI in Patients with Transient Ischemic Attack or Minor Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Joon Hwa Lee ◽  
Hyunjin Jo ◽  
Jihoon Cha ◽  
Woo-Keun Seo ◽  
Oh Young Bang ◽  
...  
Keyword(s):  
Cardiovascular Event ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Perfusion Mri ◽  
Minor Stroke ◽  
Secondary Outcome ◽  
Stroke Recurrence ◽  
Composite Outcome ◽  
Stroke Patients ◽  
Ischemic Attack

Background and purpose: We aimed to investigate the role of perfusion MRI parameters (TTP: time to peak, CBF: cerebral blood flow, CBV: cerebral blood volume) as a prognostic factor for the risk of stroke recurrence or cardiovascular outcome in patients with transient ischemic attack (TIA) or minor stroke. Methods: We retrospectively reviewed TIA or minor stroke patients who underwent our stroke MRI protocol (DWI, perfusion MRI, and MRA) in a consecutively collected stroke registry. Primary outcome was nonfatal stroke recurrence and secondary outcome was cardiovascular composite outcome. Multivariate analysis was used to examine the association of perfusion MRI parameters and angiographic findings with the risk of stroke recurrence and cardiovascular event. Results: Of the 326 patients who met inclusion criteria, we identified 15(4.6%) nonfatal strokes and 25(7.7%) cardiovascular composite events during the first 1 year after the index TIA or minor stroke. The presence of regional delayed perfusion on TTP maps (p=0.002) and regional hyperperfusion on CBV maps (p<0.001) were associated with recurrent stroke. In MRA images, concomitant stenosis of the intracranial arteries and/or extracranial carotid arteries was associated with cardiovascular events (p=0.009). Using multivariate cox proportional hazard analysis, presence of regional hyperperfusion on CBV remained an independent predictor of recurrent stroke (HR 10.82, 95% CI 4.19-38.67, p<0.001) and cardiovascular event (HR 6.30, 95% CI 2.67-18.25, p<0.001). The AUC of the CBV maps was also greater than other parameters for the prediction of stroke recurrence (AUC=0.701, 95% CI 0.54-0.86) and cardiovascular composite outcome (AUC=0.628, 95% CI 0.50-0.76). Conclusions: Increased CBV on perfusion MRI, representing the hemodynamic status of postischemic hyperperfusion, could be more useful than other perfusion parameters in predicting poor prognosis of TIA or minor stroke patients.

scholarly journals Qualitative Posttreatment Diffusion-Weighted Imaging as a Predictor of 90-day Outcome in Stroke Intervention

2019 ◽  
Vol 47 (2) ◽  
pp. 160-166
Author(s):  
Adam A Dmytriw ◽  
Abdullah Alrashed ◽  
Alejandro Enriquez-Marulanda ◽  
Shadi Daghighi ◽  
Ghouth Waggas ◽  
...  
Keyword(s):  
Diffusion Weighted Imaging ◽  
Infarct Volume ◽  
Multivariable Analysis ◽  
Poor Performance ◽  
Recombinant Tissue Plasminogen Activator ◽  
National Institutes Of Health ◽  
Infarct Core ◽  
Vessel Occlusion ◽  
Subjective Impression ◽  
Diffusion Weighted

ABSTRACT:Purpose:The aim was to assess the ability of post-treatment diffusion-weighted imaging (DWI) to predict 90-day functional outcome in patients with endovascular therapy (EVT) for large vessel occlusion in acute ischemic stroke (AIS).Methods:We examined a retrospective cohort from March 2016 to January 2018, of consecutive patients with AIS who received EVT. Planimetric DWI was obtained and infarct volume calculated. Four blinded readers were asked to predict modified Rankin Score (mRS) at 90 days post-thrombectomy.Results:Fifty-one patients received endovascular treatment (mean age 65.1 years, median National Institutes of Health Stroke Scale (NIHSS) 18). Mean infarct volume was 43.7 mL. The baseline NIHSS, 24-hour NIHSS, and the DWI volume were lower for the mRS 0–2 group. Also, the thrombolysis in cerebral infarction (TICI) 2b/3 rate was higher in the mRS 0–2 group. No differences were found in terms of the occlusion level, reperfusion technique, or recombinant tissue plasminogen activator use. There was a significant association noted between average infarct volume and mRS at 90 days. On multivariable analysis, higher infarct volume was significantly associated with 90-day mRS 3–5 when adjusted to TICI scores and occlusion location (OR 1.01; CI 95% 1.001–1.03; p = 0.008). Area under curve analysis showed poor performance of DWI volume reader ability to qualitatively predict 90-day mRS.Conclusion:The subjective impression of DWI as a predictor of clinical outcome is poorly correlated when controlling for premorbid status and other confounders. Qualitative DWI by experienced readers both overestimated the severity of stroke for patients who achieved good recovery and underestimated the mRS for poor outcome patients. Infarct core quantitation was reliable.

scholarly journals Recurrent Stroke was Associated with Poor Quality of Life in Patients with Transient Ischemic Attack or Minor Stroke: Finding from the CHANCE Trial

2014 ◽  
Vol 20 (12) ◽  
pp. 1029-1035 ◽  
Author(s):  
Yi-Long Wang ◽  
Yue-Song Pan ◽  
Xing-Quan Zhao ◽  
David Wang ◽  
S Claiborne Johnston ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Poor Quality ◽  
Minor Stroke ◽  
Ischemic Attack

scholarly journals Endovascular treatment of acute ischemic stroke in nonagenarians compared with younger patients in a multicenter cohort

2016 ◽  
Vol 9 (8) ◽  
pp. 727-731 ◽  
Author(s):  
Muhib A Khan ◽  
Grayson L Baird ◽  
David Miller ◽  
Anand Patel ◽  
Shawn Tsekhan ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
National Institutes Of Health ◽  
Small Subset ◽  
Imaging Data ◽  
Vessel Occlusion ◽  
Younger Patients ◽  
Age Cohort ◽  
Multivariable Regression ◽  
Predicting Outcome ◽  
The Relationship

BackgroundRecent studies have demonstrated the superiority of endovascular therapy (EVT) for emergent large vessel occlusion.ObjectiveTo determine the effectiveness of EVT in nonagenarians, for whom data are limited.MethodsWe retrospectively reviewed clinical and imaging data of all patients who underwent EVT at two stroke centers between January 2012 and August 2014. The 90-day functional outcome (modified Rankin Scale (mRS) score) was compared between younger patients (age 18–89 years; n=175) and nonagenarians (n=18). The relationship between pre-stroke and 90-day post-stroke mRS was analyzed in these two groups. Multivariable analysis of age, recanalization grade, and admission National Institutes of Health Stroke Scale (NIHSS) for predicting outcome was performed.ResultsAge ≥90 years was associated with a poor (mRS >2) 90-day outcome relative to those under 90 (89% vs 52%, OR=8, 95% CI 1.7 to 35.0; p=0.0081). Nonagenarians had a higher pre-stroke mRS score (0.77; 95% CI 0.44 to 1.30) than younger patients (0.24; 95% CI 0.17 to 0.35; p=0.005). No difference was observed between nonagenarians and younger patients in the rate of mRS change from pre-stroke to 90 days (p=0.540). On multivariable regression, age (OR=1.05, 95% CI 1.03 to 1.08; p<0.0001), recanalization grade (OR=0.62 95% CI 0.42 to 0.91; p=0.015), and admission NIHSS (OR=1.07 95% CI 1.02 to 1.13; p=0.01) were associated with a poor 90-day outcome.ConclusionsNonagenarians are at a substantially higher risk of a poor 90-day outcome after EVT than younger patients. However, a small subset of nonagenarians may benefit from EVT, particularly if they have a good pre-stroke functional status. Further research is needed to identify factors associated with favorable outcome in this age cohort.

Predicting recurrent stroke after minor stroke and transient ischemic attack

2009 ◽  
Vol 7 (10) ◽  
pp. 1273-1281 ◽  
Author(s):  
Philippe Couillard ◽  
Alexandre Y Poppe ◽  
Shelagh B Coutts
Keyword(s):  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Minor Stroke ◽  
Ischemic Attack

scholarly journals Time-of-Day Could Affect Cognitive Screening Performance in Older Patients with TIA and Stroke

2017 ◽  
Vol 43 (5-6) ◽  
pp. 290-293 ◽  
Author(s):  
Sara Mazzucco ◽  
Linxin Li ◽  
Maria A. Tuna ◽  
Sarah T. Pendlebury ◽  
Rhoda Frost ◽  
...  
Keyword(s):  
Cognitive Performance ◽  
Older Patients ◽  
Time Of Day ◽  
Minor Stroke ◽  
Cognitive Screening ◽  
Repeated Testing ◽  
Cross Sectional ◽  
Ischemic Attack ◽  
The Impact ◽  
Moca Score

Background and Purpose: The impact of time-of-day on the cognitive performance of older patients with limited cognitive reserve after a transient ischemic attack (TIA) or stroke, and on short cognitive tests, such as the Montreal Cognitive Assessment (MoCA), is unknown. We retrospectively studied whether morning versus afternoon assessment might affect the classification of patients aged 70 or older as severe (SCI), mild (MCI), and no (NCI) cognitive impairment by the MoCA. Methods: Morning (12 p.m. or earlier) versus afternoon (later than 12 p.m.) proportions of SCI (MoCA score <20), MCI (MoCA score 25-20) and NCI (MoCA score ≥26) were compared in a cohort of patients aged ≥70, attending a rapid-access TIA/stroke clinic. Results: Of 278 patients, 113 (40.6%) were tested in the morning and 165 (59.4%) in the afternoon. The proportion with SCI was greater in the afternoon than in the morning (10.9 vs. 1.8%, respectively, p = 0.004), with no difference in age, education, diagnosis, disability, or vascular risk factors. Conclusions: Time-of-day appears to affect cognitive performance of older patients after they undergo TIA and minor stroke. If our cross-sectional findings are confirmed in cross-over studies with repeated testing, timing of assessments should be considered in clinical practice and in research studies.

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