Minor stroke and transient ischemic attack（TIA）are common disorders with a high rate of subsequent disabling stroke, so the early recognition and management of minor stroke and TIA is of great importance. At the mom...Minor stroke and transient ischemic attack（TIA）are common disorders with a high rate of subsequent disabling stroke, so the early recognition and management of minor stroke and TIA is of great importance. At the moment, the diagnosis of these disorders is based on neurologic deficits in a stroke-clinician＇s examination of the patient, supplemented by the results of acute brain imaging.However, high variability in TIA diagnosis has been reported between physicians, even trained vascular neurologists, and image-based diagnostic confirmation is not always readily available. Some patients still have ischemic events despite sustained standard secondary preventive therapy. Blood biomarkers are promising to aid in the diagnosis, risk stratification, and individual treatment of minor stroke and TIA. Some studies are being conducted in this field. This mini-review aims to highlight potential biomarkers for diagnosis and those helpful in predicting the risk of future stroke and the selection of treatment.展开更多
Objectives Despite the potential spillover effect,the optimal duration of dual antiplatelet therapy for minor stroke within 72 hours of symptom onset is still uncertain.Methods Safety and Efficacy of Aspirin-Clopidogr...Objectives Despite the potential spillover effect,the optimal duration of dual antiplatelet therapy for minor stroke within 72 hours of symptom onset is still uncertain.Methods Safety and Efficacy of Aspirin-Clopidogrel in Acute Noncardiogenic Minor Ischemic Stroke(National Institutes of Health Stroke Scale(NIHSS)score≤5)is a prospective cohort study involving patients with minor ischaemic stroke within 72 hours of symptom onset.The DAPT group was further categorised into three subgroups:shorter duration(<10 days),short duration(10-21 days)and long duration(>21 days).The primary efficacy and safety outcomes were composite vascular event and severe bleeding during 90 days.Results Among 3061 eligible patients(age was 61.7±12.0 years,73.3%were men,median(IQR)NIHSS score,2(1-3)),2977(97.4%)completed the follow-up.Dual antiplatelet therapy(DAPT)and single antiplatelet therapy(SAPT)were administered in 61.0%and 39.0%of patients.Among them,305 patients(16.8%)received a shorter duration of DAPT,937 patients(51.7%)received a short duration and 572 patients(31.5%)received a long duration.In the propensity-weighted Cox proportional hazards regression analysis,the use of DAPT in the short-duration group was associated with a lower risk of the primary vascular event outcome(HR(HR)=0.66,95%CI 0.46 to 0.94,p=0.02)compared with SAPT group.The incidence of severe bleeding events at 90 days was similar.Similar findings were obtained from the propensity score-matching analysis.Conclusion Short duration of DAPT(10-21 days)is superior to SAPT in minor stroke within 72 hours,reducing 90-day composite vascular events without increasing bleeding risk.展开更多
Mild stroke symptoms are cited as the reason for not using tissue-type plasminogen activator in 29–43%of time-eligible patients.Previous studies suggested that not all of these patients had a good recovery or even su...Mild stroke symptoms are cited as the reason for not using tissue-type plasminogen activator in 29–43%of time-eligible patients.Previous studies suggested that not all of these patients had a good recovery or even survival to hospital discharge.Since then,stroke guidelines worldwide recommended thrombolysis in minor but disabling strokes.Dual antiplatelet treatment with aspirin and clopidogrel was more effective than aspirin alone for reducing subsequent events in patients with minor stroke if started within 24 hours of onset in both CHANCE(Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events)and POINT(Platelet-Oriented Inhibition in New TIA and Minor Ischaemic Stroke)trials.Recently,both PRISMS(The Potential of rtPA for Ischemic Strokes With Mild Symptoms)trial and TEMPO-2(Tenecteplase Versus Standard of Care for Minor Ischemic Stroke With Proven Occlusion)trial showed that treatment with thrombolysis versus antiplatelet did not increase the likelihood of favourable functional outcome at 90 days among patients with minor non-disabling acute ischaemic strokes.Therefore,a narrative review on thrombolysis for patients with minor strokes from published studies may help practicing clinicians.展开更多
BACKGROUND The identification of risk factors for recurrence in patients with minor ischemic stroke(MIS)is a critical medical need.AIM To develop a nomogram for individualized prediction of in-hospital recurrence in M...BACKGROUND The identification of risk factors for recurrence in patients with minor ischemic stroke(MIS)is a critical medical need.AIM To develop a nomogram for individualized prediction of in-hospital recurrence in MIS patients.METHODS Based on retrospective collection,a single-center study was conducted at the First Affiliated Hospital of Anhui Medical University from January 2014 to December 2019.Univariate and multivariate logistic regression analyses were used to determine the risk factors associated with MIS recurrence.The least absolute shrinkage and selection operator regression was performed for preliminary identification of potential risk factors.Uric acid,systolic blood pressure,serum total bilirubin(STBL),and ferritin were integrated for nomogram construction.The predictive accuracy and calibration of the nomogram model were assessed by the area under the receiver operating characteristic curve(AUC-ROC)and Hosmer-Lemeshow test,respectively.RESULTS A total of 2216 MIS patients were screened.Among them,155 were excluded for intravascular therapy,146 for unknown National Institutes of Health Stroke Scale score,195 for intracranial hemorrhage,and 247 for progressive stroke.Finally,1244 patients were subjected to further analysis and divided into a training set(n=796)and a validation set(n=448).Multivariate logistic regression analysis revealed that uric acid[odds ratio(OR):0.997,95%confidence interval(CI):0.993-0.999],ferritin(OR:1.004,95%CI:1.002-1.006),and STBL(OR:0.973,95%CI:0.956-0.990)were independently associated with in-hospital recurrence in MIS patients.Our model showed good discrimination;the AUC-ROC value was 0.725(95%CI:0.646-0.804)in the training set and 0.717(95%CI:0.580-0.785)in the validation set.Moreover,the calibration between nomogram prediction and the actual observation showed good consistency.Hosmer-Lemeshow test results confirmed that the nomogram was well-calibrated(P=0.850).CONCLUSION Our present findings suggest that the nomogram may provide individualized prediction of recurrence in MIS patients.展开更多
Background: As a common and high incidence of disease, the minor ischemic stroke (MIS) has become an important public health problem. The aim of this study was to address whether patients with MIS have different types...Background: As a common and high incidence of disease, the minor ischemic stroke (MIS) has become an important public health problem. The aim of this study was to address whether patients with MIS have different types and outcome in the elderly in northern China. Methods: A retrospective cohort of consecutive patients was selected for study;all registered neurologic outpatients of the tertiary teaching hospital in northern Jiangsu, China between February, 2011 and February, 2012. A total of 433 outpatients, clinically only having had an initial visit and a MRI study of the brain, were enrolled. Results: Of 433 outpatients, 247 (57.0%) patients with MIS were diagnosed. The clinical types of MIS included stable MIS in 58.3%, acute progressive MIS in 5.3%, and chronic progressive MIS in 36.4% of patients. After adjusted Odd ratio (OR), only aged (OR, 1.0;95% confidence interval [CI], 1.007 - 1.087, p = 0.021), episode duration (OR, 1.8;95% CI, 1.011 - 1.024, p = 0.001), initial number of MIS (OR, 1.1;95% CI, 1.047 - 1.207, p = 0.001), and infarcts volume (OR, 1.8;95% CI, 1.253 - 2.681, p = 0.002) were independently associated with stable MIS and progressive MIS. Total survival was favorable among groups (p = 0.094), but the followed mRS score was significantly higher among those progressive MIS than those stable MIS (2.3 ± 1.0 vs 0.1 ± 0.3, p Conclusion: MIS had a very high prevalence and different clinical types. Stable MIS is a benign stroke, whereas those progressive MIS may have long-term instability or acute and chronic progressive trend. This information is important in prospectively determining outcome of MIS and in patient treatment.展开更多
The term "mild stroke",or "minor stroke" refers to the acute ischemic stroke patients with mild and nondisabling symptoms. Currently there is still no unanimous consensus on the exact definition of...The term "mild stroke",or "minor stroke" refers to the acute ischemic stroke patients with mild and nondisabling symptoms. Currently there is still no unanimous consensus on the exact definition of mild stroke. Patients with mild stroke are assumed to have a good prognosis in natural course,so they are routinely not given thrombolysis despite early emergency department arrival. Recent studies have revealed that,however,approximately one third of so-called mild stroke patients who are not treated with thrombolysis have significant disability whereas those treated are more likely to achieve a good recovery. Thus excluding all mild strokes from thrombolysis is probably not justified. Those mild stroke patients who are likely to experience early deterioration or end with disability are mostly characterized by imaging findings. Therefore,selected patients with these characteristics based on neuroimaging to be given thrombolysis might be more justified. Meanwhile,new definition should be developed to exclude those who are at a higher risk of poor outcome. Applying information from imaging may make it come true. Using neuroimaging information to define mild stroke and select patients with mild symptoms to thrombolysis may be a future direction.展开更多
文摘Minor stroke and transient ischemic attack（TIA）are common disorders with a high rate of subsequent disabling stroke, so the early recognition and management of minor stroke and TIA is of great importance. At the moment, the diagnosis of these disorders is based on neurologic deficits in a stroke-clinician＇s examination of the patient, supplemented by the results of acute brain imaging.However, high variability in TIA diagnosis has been reported between physicians, even trained vascular neurologists, and image-based diagnostic confirmation is not always readily available. Some patients still have ischemic events despite sustained standard secondary preventive therapy. Blood biomarkers are promising to aid in the diagnosis, risk stratification, and individual treatment of minor stroke and TIA. Some studies are being conducted in this field. This mini-review aims to highlight potential biomarkers for diagnosis and those helpful in predicting the risk of future stroke and the selection of treatment.
文摘Objectives Despite the potential spillover effect,the optimal duration of dual antiplatelet therapy for minor stroke within 72 hours of symptom onset is still uncertain.Methods Safety and Efficacy of Aspirin-Clopidogrel in Acute Noncardiogenic Minor Ischemic Stroke(National Institutes of Health Stroke Scale(NIHSS)score≤5)is a prospective cohort study involving patients with minor ischaemic stroke within 72 hours of symptom onset.The DAPT group was further categorised into three subgroups:shorter duration(<10 days),short duration(10-21 days)and long duration(>21 days).The primary efficacy and safety outcomes were composite vascular event and severe bleeding during 90 days.Results Among 3061 eligible patients(age was 61.7±12.0 years,73.3%were men,median(IQR)NIHSS score,2(1-3)),2977(97.4%)completed the follow-up.Dual antiplatelet therapy(DAPT)and single antiplatelet therapy(SAPT)were administered in 61.0%and 39.0%of patients.Among them,305 patients(16.8%)received a shorter duration of DAPT,937 patients(51.7%)received a short duration and 572 patients(31.5%)received a long duration.In the propensity-weighted Cox proportional hazards regression analysis,the use of DAPT in the short-duration group was associated with a lower risk of the primary vascular event outcome(HR(HR)=0.66,95%CI 0.46 to 0.94,p=0.02)compared with SAPT group.The incidence of severe bleeding events at 90 days was similar.Similar findings were obtained from the propensity score-matching analysis.Conclusion Short duration of DAPT(10-21 days)is superior to SAPT in minor stroke within 72 hours,reducing 90-day composite vascular events without increasing bleeding risk.
文摘Mild stroke symptoms are cited as the reason for not using tissue-type plasminogen activator in 29–43%of time-eligible patients.Previous studies suggested that not all of these patients had a good recovery or even survival to hospital discharge.Since then,stroke guidelines worldwide recommended thrombolysis in minor but disabling strokes.Dual antiplatelet treatment with aspirin and clopidogrel was more effective than aspirin alone for reducing subsequent events in patients with minor stroke if started within 24 hours of onset in both CHANCE(Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events)and POINT(Platelet-Oriented Inhibition in New TIA and Minor Ischaemic Stroke)trials.Recently,both PRISMS(The Potential of rtPA for Ischemic Strokes With Mild Symptoms)trial and TEMPO-2(Tenecteplase Versus Standard of Care for Minor Ischemic Stroke With Proven Occlusion)trial showed that treatment with thrombolysis versus antiplatelet did not increase the likelihood of favourable functional outcome at 90 days among patients with minor non-disabling acute ischaemic strokes.Therefore,a narrative review on thrombolysis for patients with minor strokes from published studies may help practicing clinicians.
基金Supported by the National Natural Science Foundation of China(No.81771154)the Natural Science Foundation of Anhui Province(No.1908085QH322).
文摘BACKGROUND The identification of risk factors for recurrence in patients with minor ischemic stroke(MIS)is a critical medical need.AIM To develop a nomogram for individualized prediction of in-hospital recurrence in MIS patients.METHODS Based on retrospective collection,a single-center study was conducted at the First Affiliated Hospital of Anhui Medical University from January 2014 to December 2019.Univariate and multivariate logistic regression analyses were used to determine the risk factors associated with MIS recurrence.The least absolute shrinkage and selection operator regression was performed for preliminary identification of potential risk factors.Uric acid,systolic blood pressure,serum total bilirubin(STBL),and ferritin were integrated for nomogram construction.The predictive accuracy and calibration of the nomogram model were assessed by the area under the receiver operating characteristic curve(AUC-ROC)and Hosmer-Lemeshow test,respectively.RESULTS A total of 2216 MIS patients were screened.Among them,155 were excluded for intravascular therapy,146 for unknown National Institutes of Health Stroke Scale score,195 for intracranial hemorrhage,and 247 for progressive stroke.Finally,1244 patients were subjected to further analysis and divided into a training set(n=796)and a validation set(n=448).Multivariate logistic regression analysis revealed that uric acid[odds ratio(OR):0.997,95%confidence interval(CI):0.993-0.999],ferritin(OR:1.004,95%CI:1.002-1.006),and STBL(OR:0.973,95%CI:0.956-0.990)were independently associated with in-hospital recurrence in MIS patients.Our model showed good discrimination;the AUC-ROC value was 0.725(95%CI:0.646-0.804)in the training set and 0.717(95%CI:0.580-0.785)in the validation set.Moreover,the calibration between nomogram prediction and the actual observation showed good consistency.Hosmer-Lemeshow test results confirmed that the nomogram was well-calibrated(P=0.850).CONCLUSION Our present findings suggest that the nomogram may provide individualized prediction of recurrence in MIS patients.
文摘Background: As a common and high incidence of disease, the minor ischemic stroke (MIS) has become an important public health problem. The aim of this study was to address whether patients with MIS have different types and outcome in the elderly in northern China. Methods: A retrospective cohort of consecutive patients was selected for study;all registered neurologic outpatients of the tertiary teaching hospital in northern Jiangsu, China between February, 2011 and February, 2012. A total of 433 outpatients, clinically only having had an initial visit and a MRI study of the brain, were enrolled. Results: Of 433 outpatients, 247 (57.0%) patients with MIS were diagnosed. The clinical types of MIS included stable MIS in 58.3%, acute progressive MIS in 5.3%, and chronic progressive MIS in 36.4% of patients. After adjusted Odd ratio (OR), only aged (OR, 1.0;95% confidence interval [CI], 1.007 - 1.087, p = 0.021), episode duration (OR, 1.8;95% CI, 1.011 - 1.024, p = 0.001), initial number of MIS (OR, 1.1;95% CI, 1.047 - 1.207, p = 0.001), and infarcts volume (OR, 1.8;95% CI, 1.253 - 2.681, p = 0.002) were independently associated with stable MIS and progressive MIS. Total survival was favorable among groups (p = 0.094), but the followed mRS score was significantly higher among those progressive MIS than those stable MIS (2.3 ± 1.0 vs 0.1 ± 0.3, p Conclusion: MIS had a very high prevalence and different clinical types. Stable MIS is a benign stroke, whereas those progressive MIS may have long-term instability or acute and chronic progressive trend. This information is important in prospectively determining outcome of MIS and in patient treatment.
文摘The term "mild stroke",or "minor stroke" refers to the acute ischemic stroke patients with mild and nondisabling symptoms. Currently there is still no unanimous consensus on the exact definition of mild stroke. Patients with mild stroke are assumed to have a good prognosis in natural course,so they are routinely not given thrombolysis despite early emergency department arrival. Recent studies have revealed that,however,approximately one third of so-called mild stroke patients who are not treated with thrombolysis have significant disability whereas those treated are more likely to achieve a good recovery. Thus excluding all mild strokes from thrombolysis is probably not justified. Those mild stroke patients who are likely to experience early deterioration or end with disability are mostly characterized by imaging findings. Therefore,selected patients with these characteristics based on neuroimaging to be given thrombolysis might be more justified. Meanwhile,new definition should be developed to exclude those who are at a higher risk of poor outcome. Applying information from imaging may make it come true. Using neuroimaging information to define mild stroke and select patients with mild symptoms to thrombolysis may be a future direction.
