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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Thirty-day recurrence after ischemic stroke or TIA.

Andrej Netland Khanevski1,2,3, Anna Therese Bjerkreim1,2, Vojtech Novotny1,2

  • 1Department of Clinical Medicine, University of Bergen, Bergen, Norway.

Brain and Behavior
|September 18, 2018
PubMed
Summary

Early stroke recurrence is highest within 30 days. Extracranial large artery atherosclerosis and other determined etiologies significantly increase this risk, with TOAST classification often inadequate for identifying causes.

Keywords:
cerebrovascular diseaseischemic strokereadmissionstroke etiologystroke recurrence

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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.