Incidence and outcoMes of MInor stroke and high-risk traNsient ischEmic attack in NordicTus. IMMINENT study.
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Ramos-Araque M E, Castellanos M, Naya Rios L, López-Cancio E, Molina Gil J, Marta-Moreno J, Tejada-Meza H, Temprano Fernández M, Antón González C, Vidal de Francisco D, Tejada-García J, Maciñeiras Montero J L, Vicente Alba P, García-Sánchez J M, Aguilera Irazabal B, Martínez-Zabaleta M, Diez I N, Pinedo Brochado A, Azkune Calle I, Freijo M M, Moreno-Estebanez A, Palacio-Portilla E, Manrique Arregui L, Rodríguez-Yáñez M, Santamaría-Cadavid M, Timiraos-Fernández J J, Herrero Infante Y, Trejo-Gabriel-Galán J, Echavarria-Iñiguez A, Tejero-Juste C, Rodríguez Montolio J, Julián-Villaverde F, Moreno García M, López-Mesonero L, Redondo-Robles L, Aymerich N, Korroza J, Arenillas J F, NORDICTUS Investigators
Аннотация
METHODS: We retrospectively reviewed data from all stroke patients evaluated at the emergency department of 19 hospitals belonging to the NORDICTUS stroke network between July and December 2019. Consecutive patients with non-cardioembolic minor AIS (NIHSS ≤5) and high-risk TIA (ABCD2 ≥6 or ipsilateral stenosis ≥50%) were included. We recorded clinical, neuroimaging and therapeutic variables. Follow-up was performed at 30 and 90 days. Functional prognosis was assessed with the modified Rankin scale score (mRS).
RESULTS: Of 8275 patients, 1679 (20%) fulfilled IMMINENT criteria (1524 AIS/155 TIA), resulting in a global incidence of 48/100,000 inhabitants per-year. Recurrent stroke/death occurred in 73 (4.3%) patients. Extracranial ipsilateral stenosis (>50%): HR 1.999 (95% CI: 1.115-3.585, p=0.020) and lack of hyperacute cerebral arterial assessment: HR 1.631 (95% CI: 1.009-2.636, p=0.046) were associated with recurrent stroke/death at 90 days. Intracranial stenosis was associated with poor prognosis (p=0.044). Reperfusion therapy was given to 147 (9%) and urgent double antiplatelet therapy (DAPT) to 320 (21%) patients.
CONCLUSION: Twenty percent of our stroke patients presented as non-cardioembolic high-risk TIA or minor AIS. Extracranial ipsilateral stenosis and lack of hyperacute cerebral arterial assessment were predictors of stroke recurrence/death; intracranial stenosis was associated with poor outcome. Despite current recommendations there was a low penetrance of DAPT.