Incidence and outcoMes of MInor stroke and high-risk traNsient ischEmic attack in NordicTus. IMMINENT study

Autores de IDIVAL

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  Enrique Jesús Palacio Portilla

  Autor

Autores ajenos al IDIVAL

• Ramos-Araque, M. E.
• Castellanos, M.
• Rios, L. Naya
• Lopez-Cancio, E.
• Gil, J. Molina
• Marta-Moreno, J.
• Tejada-Meza, H.
• Fernandez, M. Temprano
• Gonzalez, C. Anton
• de Francisco, D. Vidal
• Tejada-Garcia, J.
• Montero, J. L. Macineiras
• Alba, P. Vicente
• Garcia-Sanchez, J. M.
• Irazabal, B. Aguilera
• Martinez-Zabaleta, M.
• Diez, I. N.
• Brochado, A. Pinedo
• Calle, I. Azkune
• Freijo, M. M.
• Moreno-Estebanez, A.
• Arregui, L. Manrique
• Rodriguez-Yanez, M.
• Santamaria-Cadavid, M.
• Timiraos-Fernandez, J. J.
• Infante, Y. Herrero
• Trejo-Gabriel-Galan, J.
• Echavarria-Iniguez, A.
• Tejero-Juste, C.
• Montolio, J. Rodriguez
• Julian-Villaverde, F.
• Garcia, M. Moreno
• Lopez-Mesonero, L.
• Redondo-Robles, L.
• Aymerich, N.
• Korroza, J.
• Arenillas, J. F.
• NORDICTUS Investigators

Unidades

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  CEFALEAS Y OTRAS ENFERMEDADES NEUROLÓGICAS NO DEGENERATIVAS

Abstract

Background: Our primary aim was to investigate the incidence of non-cardioembolic minor acute ischemic stroke (AIS) and high-risk transient ischemic attack (TIA) and to identify predictors of stroke recurrence/death and severe bleeding. We also evaluated the rates of TIA, major vascular events, therapeutic management and predictors of poor functional outcome at 3 months in these patients. Methods: We retrospectively reviewed data from all stroke patients evaluated at the emergency department of 19 hospitals belonging to the NORDICTUS stroke network between July and December 2019. Consecutive patients with non-cardioembolic minor AIS (NIHSS <= 5) and high-risk TIA (ABCD2 >= 6 or ipsilateral stenosis >= 50%) were included. We recorded clinical, neuroimaging and therapeutic variables. Follow-up was performed at 30 and 90 days. Functional prognosis was assessed with the modified Rankin scale score (mRS). Results: Of 8275 patients, 1679 (20%) fulfilled IMMINENT criteria (1524 AIS/155 TIA), resulting in a global incidence of 48/100,000 inhabitants per-year. Recurrent stroke/death occurred in 73 (4.3%) patients. Extracranial ipsilateral stenosis (>50%): HR 1.999 (95% CI: 1.115-3.585, p = 0.020) and lack of hyperacute cerebral arterial assessment: HR 1.631 (95% CI: 1.009-2.636, p = 0.046) were associated with recurrent stroke/death at 90 days. Intracranial stenosis was associated with poor prognosis (p = 0.044). Reperfusion therapy was given to 147 (9%) and urgent double antiplatelet therapy (DAPT) to 320 (21%) patients. Conclusion: Twenty percent of our stroke patients presented as non-cardioembolic high-risk TIA or minor AIS. Extracranial ipsilateral stenosis and lack of hyperacute cerebral arterial assessment were predictors of stroke recurrence/death; intracranial stenosis was associated with poor outcome. Despite current recommendations there was a low penetrance of DAPT. (c) 2024 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/ 4.0/).