Thirty-day recurrence after ischemic stroke or TIA

Area of Science:

• Neurology
• Cardiovascular Medicine
• Epidemiology

Background:

• Recurrent stroke incidence peaks within 30 days post-initial ischemic stroke (IS) or transient ischemic attack (TIA).
• Limited knowledge exists regarding the specific etiological factors driving early stroke recurrence.
• Understanding these factors is crucial for timely intervention and secondary prevention strategies.

Purpose of the Study:

• To identify etiological groups with the highest risk of early stroke recurrence (within 30 days).
• To evaluate the effectiveness of the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification in identifying the etiology of index strokes that lead to early recurrence.

Main Methods:

• Retrospective review of medical records for 1874 IS and TIA patients from the Bergen NORSTROKE registry.
• Identification of recurrent IS or TIA events within 30 days of the index event.
• Logistic regression analysis to determine odds ratios (OR) for 30-day recurrence, assessing etiological factors.

Main Results:

• 1.8% (33 patients) experienced recurrent IS or TIA within 30 days.
• Identified etiologies for recurrence included extracranial large artery atherosclerosis (LAA) in 42.4% and other determined etiologies (SOE) in 18.2%.
• LAA (OR=4.36) and SOE (OR=9.72) were associated with a significantly increased risk of 30-day recurrence.

Conclusions:

• Patients with LAA and SOE face a higher risk of early stroke recurrence within 30 days.
• The TOAST classification system demonstrated limitations in accurately identifying the precise etiologies of strokes that subsequently recurred early.