BMJ: Stroke is no small matter! How can I better identify the risk of stroke after TIA?

Transient cerebral isoemia attack (TIA) is a transient blood supply shortage in the cervical artery or vertebral-substrate artery system, which causes sudden, transient, reversible neurological dysfunction caused by isothermic cerebral isemia.
TIA seizures last for several minutes and usually recover completely within 30 minutes.
TIA onset generally has no precursor, there is a sexual nervous system positioning signs, but there is no evidence of responsible lesions.
TIA is commonly known as a "small stroke" because patients tend to recover fully within 24 hours, with no sequelae.
, however, previous studies have found that TIA patients have a high risk of early stroke, with a 4% to 10% incidence of cerebral infarction within 7 days of onset.
The incidence of cerebral infarction increased not only (10%-20%) within 90 days of the onset of TIA, but also the risk of myocardial infarction and sudden death, so 90 days is now consistently regarded as a "high risk period" for cerebral infarction.
so how can we better identify the risk of stroke after TIA? Currently, the best assessment for TIA seizures is the ASCD2 score.
, however, the score does not accurately distinguish between high-risk and low-risk TIA patients.
, a professor of emergency medicine from the University of Ottawa in Canada summarized Canada's transient ischemia attack score (CTIAS) from nearly 4,000 prospective registered patients in the emergency departments of eight major hospitals in Canada.
, the team conducted a five-year study that included 7,607 TIA patients in 13 emergency centers to verify the accuracy of CTIAS's assessment of stroke risk after an emergency TIA attack.
results were published recently in the English Medical Journal (BMJ).
results of this study were stroke after TIA or endometriosis/cervical artery stent implantation.
secondary result is a follow-up stroke within 7 days (with or without endometriosis/cervical stent implantation).
phone follow-up used validated questionnaires on the 7th and 90th days to verify that there was no stroke.
results showed that of the 7607 patients, 108 (1.4%) had follow-up stroke within 7 days, 83 (1.1%) had endometriosis/cervical artery stent implantation within 7 days, and 9 had both operations.
, the CTIAS score was more accurate in distinguishing the risk of subsequent stroke within 7 days, as well as the endometriosis/cervical artery stentization than ABCD2.
further analysis showed that the CTIAS score would be 70% accurate in patient risk stratation, higher than ABCD2 accuracy (60%).
addition, the results suggest that the results of subsequent strokes are similar whether or not endometriosis/cervical stent implants are performed within 7 days.
, TIA is small and the risk of stroke is not small! CTIAS effectively stratostises the risk of a patient's 7-day stroke.
this proven risk assessment into the management plan in the future will enable early decisions to improve hospitalization benefits, timing of investigations, and prioritization of specialist referrals in emergency care visits.
references: Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for stroke after risk transient ischaemic attack: multicentre prospective cohort study. BMJ 2021; 372 doi: MedSci Original Source: MedSci Original Copyright Notice: All text, images and audio and video materials on this website that indicate "Source: Mets Medicine" or "Source: MedSci Originals" are owned by Mets Medicine and are not authorized to be reproduced by any media, website or individual, and are authorized to be reproduced with the words "Source: Mets Medicine".
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