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Recurrent Ischemic Stroke - A Systematic Review and Meta-Analysis.

Mia Kolmos1, Laura Christoffersen2, Christina Kruuse3

  • 1Herlev Gentofte Hospital, Department of Neurology, Neurovascular Research, Unit, Denmark.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|June 21, 2021
PubMed
Summary

Recurrent stroke rates are high, especially for large artery atherosclerosis and cardioembolic strokes. Small vessel occlusion strokes have lower recurrence, but with varied patterns. Risk factors like hypertension and diabetes persist.

Keywords:
Secondary preventionStroke recurrenceStroke subtypeTOAST-criteria

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Area of Science:

  • Neurology
  • Cardiovascular Research
  • Public Health

Background:

  • Recurrent stroke poses a significant clinical challenge despite immediate secondary prevention efforts.
  • Stroke subtype classification is crucial as it may influence recurrence risk and necessitate tailored preventive strategies.

Purpose of the Study:

  • To investigate stroke recurrence rates specific to different stroke subtypes.
  • To identify associated risk factors for stroke recurrence over time.

Main Methods:

  • A systematic review of PubMed and Embase databases was conducted.
  • Included studies focused on adult first-ever ischemic stroke with TOAST criteria and at least 1-year follow-up.
  • Meta-analysis was performed to determine the overall stroke recurrence rate.

Main Results:

  • Twenty-six studies were analyzed, with recurrence rates varying from 5.7% to 51.3%.
  • Large artery atherosclerosis (LAA) and cardioembolic (CE) strokes showed the highest recurrence rates, often matching the index stroke subtype.
  • Small vessel occlusion (SVO) strokes had lower recurrence rates but a more diverse pattern of recurrence.
  • Hypertension, diabetes mellitus, atrial fibrillation, prior transient ischemic attack, and stroke severity were identified as independent risk factors.

Conclusions:

  • Stroke recurrence rates appear stable over time, even with secondary prevention.
  • LAA and CE strokes exhibit the highest recurrence, typically of the same subtype.
  • SVO strokes demonstrate a lower recurrence rate with varied patterns, underscoring the need for thorough investigation in all subtypes.
  • Further research is required to develop more effective preventive treatments and enhance patient adherence to risk factor management to reduce stroke recurrence.