Long-Term Risk of Stroke After Transient Ischemic Attack or Minor Stroke: A Systematic Review and Meta-Analysis
, Faizan Khan1, Vignan Yogendrakumar2,3
1Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
JAMA
|March 26, 2025
Summary
Patients experiencing a transient ischemic attack (TIA) or minor stroke face a significant long-term risk of recurrent stroke. This study highlights the urgent need for enhanced stroke prevention strategies for these individuals.
Area of Science:
- Neurology
- Epidemiology
- Public Health
Background:
- The long-term risk of stroke following a transient ischemic attack (TIA) or minor stroke is not well-established.
- Understanding this risk is crucial for effective secondary prevention strategies.
Purpose of the Study:
- To determine the annual incidence and cumulative rates of stroke up to 10 years post-TIA or minor stroke.
- To identify factors influencing stroke risk in this patient population.
Main Methods:
- A systematic review and meta-analysis of prospective and retrospective cohort studies.
- Inclusion of studies with a minimum 1-year follow-up in patients with TIA or minor stroke.
- Pooled analysis of aggregate-level data from 38 studies involving 171,068 patients.
Main Results:
- The pooled stroke incidence was 5.94 per 100 person-years in the first year, decreasing to 1.80 and 1.72 annually in subsequent periods.
- The cumulative incidence of stroke reached 12.5% at 5 years and 19.8% at 10 years.
- Higher stroke rates were observed in North America and Asia, in recent cohorts, and with active outcome ascertainment.
Conclusions:
- Patients with a history of TIA or minor stroke are at a persistently high risk of subsequent stroke.
- The findings emphasize the critical need for improved and sustained long-term stroke prevention measures for this vulnerable group.
Related Concept Videos
01:29Stroke: Introduction and Types
55
A stroke is an acute neurological event caused by the sudden disruption of cerebral blood flow, leading to rapid loss of neuronal function. Neurons depend on continuous oxygen and glucose supply, so even brief interruptions can cause irreversible injury within minutes. Strokes are classified into ischemic and hemorrhagic types.Ischemic StrokeIschemic strokes are most common and occur due to arterial occlusion, depriving brain tissue of oxygen and nutrients. This leads to energy failure, ionic...
55
01:15Ischemic Stroke l: Introduction
44
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.
44
01:15Ischemic Stroke ll: Pathophysiology
54
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...
54
01:17Hemorrhagic Stroke l: Introduction
20
A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
20
01:29Hemorrhagic Stroke ll: Pathophysiology
30
A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
30
01:26Transient Ischemic Attack l: Introduction
18
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...
18