Related Experiment Video
Updated: May 27, 2026
09:21
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Thrombolytic therapy for acute ischemic stroke after recent transient ischemic attack
María Alonso de Leciñana1, Blanca Fuentes, Jaime Masjuan
1Stroke Unit, Department of Neurology, University Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá de Henares, Madrid, Spain. malonsoc.hrc@salud.madrid.org
Summary
A prior transient ischemic attack (TIA) does not significantly impact outcomes for stroke patients receiving intravenous thrombolysis. These patients do not face an increased risk of bleeding complications after treatment.
Area of Science:
- Neurology
- Vascular Neurology
- Emergency Medicine
Background:
- The safety and efficacy of intravenous thrombolysis for stroke patients with a recent transient ischemic attack (TIA) remain debated.
- Patients with TIA may show diffusion-weighted imaging lesions, raising concerns about hemorrhage risk post-thrombolysis, despite normal CT scans.
- Prior ipsilateral TIA might offer protection through ischemic preconditioning, a factor influencing treatment outcomes.
Purpose of the Study:
- To assess the outcomes of intravenous thrombolysis in acute stroke patients who experienced a prior transient ischemic attack (TIA).
- To determine if a history of TIA influences the risk of symptomatic intracranial hemorrhage, mortality, or functional independence after thrombolysis.
Main Methods:
- A multicentered prospective study involving consecutive acute stroke patients treated with intravenous tissue plasminogen activator (tPA).
- Data collected included ipsilateral TIA history, baseline characteristics, risk factors, stroke etiology, and time to treatment.
- Outcomes measured were National Institutes of Health Stroke Scale at 7 days, modified Rankin Scale at 3 months, symptomatic intracranial hemorrhage, and mortality, comparing patients with and without prior TIA.
Main Results:
- Of 877 patients, 60 (6.84%) had a prior ipsilateral TIA, often within 24 hours.
- TIA patients were more likely to be male, younger, smokers, and have large vessel disease.
- Despite earlier treatment in TIA patients, regression analysis revealed no significant association between prior TIA and stroke outcomes, including independence, mortality, or symptomatic intracranial hemorrhage after adjusting for confounders.
Conclusions:
- A preceding transient ischemic attack (TIA) does not appear to significantly alter outcomes for patients undergoing thrombolysis for ischemic stroke.
- Patients with a history of ipsilateral TIA do not exhibit an elevated risk of bleeding complications following thrombolytic therapy.
Related Concept Videos
01:26Transient Ischemic Attack l: Introduction
A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...
01:29Venous Thrombosis III: Interprofessional Care
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
01:15Ischemic Stroke ll: Pathophysiology
An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
01:15Ischemic Stroke l: Introduction
Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
01:28Acute Coronary Syndrome IV: Interprofessional Care
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...