Early Recurrence of Cerebrovascular Events After Transient Ischaemic Attack
2004; Lippincott Williams & Wilkins; Volume: 36; Issue: 1 Linguagem: Inglês
10.1161/01.str.0000149929.92356.f1
ISSN1524-4628
AutoresMartin A Whitehead, John McManus, Christine McAlpine, Peter Langhorne,
Tópico(s)Intracranial Aneurysms: Treatment and Complications
ResumoHomeStrokeVol. 36, No. 1Early Recurrence of Cerebrovascular Events After Transient Ischaemic Attack Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBEarly Recurrence of Cerebrovascular Events After Transient Ischaemic Attack M.A. Whitehead J. McManus C. McAlpine P. Langhorne M.A. WhiteheadM.A. Whitehead Department of Aging and Health, Stirling Royal Infirmary, Livilands, Stirling, Scotland, UK J. McManusJ. McManus Falkirk and District Royal Infirmary, Falkirk, Scotland, UK C. McAlpineC. McAlpine Department of Medicine for the Elderly, Stobhill Hospital, Glasgow, Scotland, UK P. LanghorneP. Langhorne Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, UK Originally published1 Jan 2005https://doi.org/10.1161/01.STR.0000149929.92356.f1Stroke. 2005;36:1To the Editor:We read with great interest the recent article by Lisabeth et al1 regarding the stroke risk after a transient ischemic attack (TIA). Their results are similar to those reported in the mid- and late-1990s2,3 and considerably lower than more recent studies reported in the UK4,5 and Canada.6 We run rapid access TIA clinics for the assessment and investigation of individuals referred by their general practitioner following a suspected cerebrovascular event that has not necessitated in-patient management. During a recent audit of this service we examined the rate of recurrent cerebrovascular events in new referrals over a 6-month period, to 2 hospitals in East Glasgow, Scotland. Information was obtained from the referral letter, clinic letters, health care practices, hospital records and investigating departments.Of 372 new referrals to the clinics, 37 (10%) did not attend, 130 (35%) had a non-cerebrovascular diagnosis, and 205 (55%) were deemed to have suffered a probable or definite new TIA (121 [32.5%]) or minor stroke (84 [22.5%]). There were 19 documented recurrent cerebrovascular events in this group giving a crude recurrence rate of 9% (95% CI, 5 to 13%), of which 10 cases (5%; 95% CI, 2 to 8%) were known to have occurred within one week, and 15 (7%; 95% CI, 4 to 11%) within one month of the initial episode.Of the patients who had an initial diagnosis of TIA there were 17 recurrent events (14%; 95% CI 8 to 20%), with 7 cases (6%; 95% CI 1 to 10%) occurring within one week, and 13 (11%; 95% CI 5 to 16%) within one month.Multivariate analysis identified current cigarette smoking as the only independent risk factor for a recurrent event.Our findings are more similar to those of Coull et al5 and Johnston et al6 and raise the concern that very early recurrence is a significant problem that will continue to grow in tandem with an ageing population. Although, it is presently unclear whether secondary preventative measures can reduce these early recurrent events, future research should be directed toward identifying the medical and organizational strategies that would best reduce the risk of such events.1 Lisabeth LD, Ireland JK, Risser J, Brown DL, Smith MA, Garcia NM, Morgenstern LB. Stroke risk after transient ischaemic attack in a population-based setting. Stroke. 2004; 35: 1842–1846.LinkGoogle Scholar2 Hankey GJ. Impact of treatment of people with transient ischaemic attacks on stroke incidence and public health. Cerebrovasc Dis. 1996; 6 (Suppl 1): 26–33.CrossrefGoogle Scholar3 Wolf PA, Claggett GP, Easton JD, Goldstein LB, Gorelick PB, Kelly-Hayes M, et al. Preventing ischemic stroke in patients with prior stroke and transient ischaemic attack: a statement for healthcare professionals from the Stroke Council of the Am Heart Association. Stroke. 1999; 30: 1991–1994.CrossrefMedlineGoogle Scholar4 Lovett JK, Dennis MS, Sandercock PA, Bamford J, Warlow CP, Rothwell PM. Very early risk of stroke after a first transient ischemic attack. Stroke. 2003; 34: e138–e140.LinkGoogle Scholar5 Coull AJ, Lovett JK, Rothwell PM. Population based study of early risk of stroke after transient ischaemic attack or minor stroke: implications for public education and organisation of services. BMJ. 2004; 328: 326.CrossrefMedlineGoogle Scholar6 Johnston SC, Gress DR, Browner WS, Sidney S. Short-term prognosis after emergency department diagnosis of TIA. JAMA. 2000; 284: 2901–2906.CrossrefMedlineGoogle ScholarstrokeahaStrokeStrokeStroke0039-24991524-4628Lippincott Williams & WilkinsLisabeth Lynda D., and Morgenstern Lewis B., 01012005Response:We would like to thank Drs Whitehead, McManus, McAlpine, and Prof Langhorne for their interest in our paper. As their letter indicates, in our paper we found stroke risk after transient ischemic attack to be somewhat lower than recent studies on this topic. We feel it is critically important to examine findings from various studies using different methods and study populations to understand the risk of stroke after TIA. To this end, our findings provide estimates of risk from a prospective, population-based study of stroke and TIA in an ethnically diverse community using rigorous case ascertainment procedures to acquire all strokes and TIAs that present for medical attention. eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By (2018) Short-Term Prognosis after Transient Ischemic Attack and Minor Stroke Transient Ischemic Attack and Stroke, 10.1017/9781316161609.016, (231-245) Wardlaw J, Brazzelli M, Miranda H, Chappell F, McNamee P, Scotland G, Quayyum Z, Martin D, Shuler K, Sandercock P and Dennis M (2014) An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke: a systematic review, meta-analysis and economic evaluation, Health Technology Assessment, 10.3310/hta18270, 18:27, (1-368) (2009) Short-term prognosis after transient ischemic attack and minor stroke Transient Ischemic Attack and Stroke, 10.1017/CBO9780511575815.016, (195-206) (2009) Prognosis of transient ischemic attack and stroke Transient Ischemic Attack and Stroke, 10.1017/CBO9780511575815.015, (179-222) Giles M and Rothwell P (2007) Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis, The Lancet Neurology, 10.1016/S1474-4422(07)70274-0, 6:12, (1063-1072), Online publication date: 1-Dec-2007. January 2005Vol 36, Issue 1 Advertisement Article InformationMetrics https://doi.org/10.1161/01.STR.0000149929.92356.f1PMID: 15618448 Originally publishedJanuary 1, 2005 PDF download Advertisement
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