Published Online
on October 25, 2007

A more recent version of this article appeared on December 1, 2007

This Article Full Text (PDF) CME: Take the course for this article: Stroke: December 2007, Volume 38, Number 12 All Versions of this Article: 38/12/3225    most recent STROKEAHA.107.488833v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Purroy, F. Articles by Álvarez-Sabín, J. Search for Related Content PubMed PubMed Citation Articles by Purroy, F. Articles by Álvarez-Sabín, J. Pubmed/NCBI databases Medline Plus Health Information Transient Ischemic Attack Related Collections Transient Ischemic Attacks

Submitted on March 20, 2007
Revised on May 9, 2007
Accepted on May 11, 2007

Patterns and Predictors of Early Risk of Recurrence After Transient Ischemic Attack With Respect to Etiologic Subtypes

Francisco Purroy MD, PhD^*; Joan Montaner MD, PhD; Carlos A. Molina MD, PhD; Pilar Delgado MD, PhD; Marc Ribo MD, PhD; and José Álvarez-Sabín MD, PhD

From the Stroke Unit (F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, Spain; and the Neurovascular Unit (J.M., C.A.M., P.D., M.R., J.A.-S.), Department of Neurology, Universitat Autònoma de Barcelona, Hospital Universitari de la Vall d’Hebron, Barcelona, Spain.

^* To whom correspondence should be addressed. E-mail: 34271fpg{at}comb.es.

Background and Purpose—The risk of recurrent stroke is highest within the first few weeks after a transient ischemic attack (TIA), and it is likely to be related to the underlying pathology. We sought to study the early risk of recurrent stroke by etiologic subtype.

Methods—We prospectively studied 388 TIA patients. The cause of TIA was classified according to the Trial of ORG 10172 criteria: large-artery atherosclerosis (LAA, n=90), cardioembolism (n=87), small-vessel disease (n=68), undetermined (n=127), and other determined cause (n=16). Patients were followed up at 3 months. Risk factors and clinical symptoms for each subtype were recorded.

Results—The duration of symptoms and clinical symptoms varied significantly among the different subtypes. LAA was associated with recurrent short episodes of weakness, whereas speech impairment and cortical symptoms were associated with cardioembolism (P<0.05). The association of vascular risk factors was highest in LAA (P<0.05). New strokes were recorded in 35 (9%) patients. Recurrent stroke risk varied among subtypes (P<0.001): LAA, 20.0%; cardioembolism, 11.5%; undetermined, 4.7%; small-vessel disease, 1.5%; and other cause, 0%. Cox proportional-hazards multivariate analyses did not identify any independent predictor of further cerebral ischemic events for LAA, cardioembolism, undetermined, or small-vessel disease.

Conclusions—The risk of early recurrent stroke is highest in patients with LAA. This supports the need for urgent carotid and transcranial imaging for identifying those patients at highest risk. Some risk factors and clinical symptoms are related to some etiologic subtypes, but stronger predictors of stroke recurrence are needed to identify those patients with highest risk for each TIA subtype.

Key words: etiology • outcome • risk factors • stroke classification • transient ischemic attack

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