Outcomes of Mild Stroke and High-risk Transient Ischemic Attack in Current Clinical Practice

Abstract

Early assessment and management of patients with mild stroke and transient ischemic attack (TIA) by specialists were recommended. Objectives: To evaluate the outcomes of these patients, and identify the predictive factors of clinical progression, unfavorable outcomes and recurrent stroke. Materials and Methods: Patients with mild ischemic stroke (NIHSS≤5) and high-risk TIA were studied. All patients were managed by stroke specialists within 24 hours of stroke onset. The outcomes of the patients at 3 months and final follow-up were studied. Predictive factors of clinical progression, unfavorable outcomes, and recurrent stroke were analyzed. Results: 254 patients were studied. Thirty-eight patients (15%) had clinical progression during admission. Large artery atherosclerosis (OR 2.49, 95%CI 1.06-5.81), cardioembolism (OR 3.34, 95%CI 1.26-8.87), and brainstem stroke (OR 2.78, 95%CI 1.28-6.01) were associated with clinical progression. At the final follow-up, median 22 months, 81 patients (32%) had unfavorable outcomes. Previous disability (OR 1.81, 95%CI 3.31-100), moderate to severe white matter lesions (OR 2.90, 95%CI 1.44-5.84), clinical progression (OR 12.5, 95%CI 5.08-31.25), and recurrent stroke (OR 8.47, 95%CI 3.21-22.72) were related to unfavorable outcomes. Eleven patients (4%) had recurrent stroke within 3 months and 31 patients (12%) at the final follow-up. Older age (OR 6.68, 95%CI 2.35-19.02), diabetes mellitus (OR 2.59, 95%CI 1.07-6.27) and smoking (OR 4.26, 95%CI 1.52-11.95) were related to recurrent stroke. Conclusion: Implementation of the up-to-date standard care in clinical practice might bring good clinical outcomes to the patients with mild stroke and high-risk TIA.