22. European Stroke Conference 576 © 2013 S. Karger AG, Basel Scientific Programme 20 Acute cerebrovascular events (ACE): TIA and minor strokes Does prior TIA have a preconditioning effect on subsequent stroke in young patients? Results from the Stroke in Young Fabry Patients (sifap1) Study A. Kahl1, U. Grittner2, R. Schmidt3, F. Fazekas4, M. Dichgans5, M. Kaps6, Ch. Kessler7, P. Martus8, C. Tanislav9, T. Tatlisumak10, B. Norrving11, A. Rolfs12, C. Enzinger13, G.J. Jungehülsing14 Department of Neurology and Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, GERMANY1, Center for Stroke Research Berlin, Department of Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, GERMANY2, Department of Neurology, Medical University of Graz, Graz, AUSTRIA3, Department of Neurology, Medical Uni-versity of Graz, Graz, AUSTRIA4, Institute for Stroke and Dementia Research, Klinikum Großhad-ern, LMU, München, München, GERMANY5, Justus Liebig University, Giessen, Giessen, GER-MANY6, Department of Neurology, University of Greifswald, Greifswald, GERMANY7, Institute for Clinical Epidemiology and Applied Biometry, Universitätsklinikum Tübingen, Tübingen, GER-MANY8, Justus Liebig University, Giessen, Giessen, GERMANY9, Department of Neurology, Helsinki University Central Hospital, Helsinki, FINLAND10, Department of Clinical Neuroscience, Lund University Hospital, Lund, SWEDEN11, Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock, GERMANY12, Department of Neurolo-gy and Department of Radiology, Division of Neuroradiology, Medical University of Graz, Graz, AUSTRIA13, Department of Neurology and Center for Stroke Research Berlin, Charité-Universitäts-medizin Berlin, Berlin, GERMANY14 Background and Purpose: The phenomenon of ischemic preconditioning (IP) is well established in animal models of brain ischemia. Human clinical studies delivered conflicting evidence of IP after prior TIA and its impact on subsequent stroke. We aimed to assess the influence of preceding TIA on stroke severity in a large population of young stroke patients. Methods We analyzed data from 4165 patients with first-ever ischemic stroke (IS) from the prospective obser-vational sifap1 study cohort (age range 18-55 years; n=5024) regarding clinical assessment, risk fac-tors, and MRI parameters. Patients were stratified on presence of absence of a previous TIA and fur-ther categorized according to the delay between preceding TIA and subsequent stroke in <1 week, 1-4 weeks, and total with TIA before first IS, respectively. Univariate and multivariate analyses were performed. Results Of the 4165 documented subjects with first IS, 122 (2.9%) patients reported a history of previous TIA. In univariate analysis based on the modified Rankin Scale, our data indicate a better clini-cal outcome for patients with a prior TIA (p=0.04). A preceding TIA was associated with obesity (28.9% vs. 20.7%; p=0.03). Baseline characteristics also show an exceeding number of relevant ACI stenosis in patients with a previous TIA (17.6% vs. 10.2%; p=0.05). Further analysis e.g. regarding the influence of TIA delay, stroke etiology (due to the TOAST classification) or regarding infarct volumes is forthcoming and will be reported in the paper. Conclusions In a large cohort of young first-ever IS patients, those with a prior TIA had less severe disability in the acute phase. 19 Acute cerebrovascular events (ACE): TIA and minor strokes Patterns and predictors of stroke recurrence after a TIA. Data from the PROMAPA registry F. Purroy1, P.E. Jiménez-Caballero2, A. Gorospe3, M.J. Torres4, J. Álvarez-Sabín5, P. Martínez-Sán-chez6, D. Cánovas7, M. Freijo8, J. A. Egido9, J. M. Ramírez-Moreno10, A. Rodríguez-Campello11, I. Casado12, J. Martí-Fàbregas13, H. Quesada14, J. Masjuán15 on behalf of the Stroke Project of the Spanish Cerebrovascular Diseases Study Group: E. Santamari-na, A. Alonso-Arias, R. Delgado-Mederos, Y. Silva, A. Morales, N. Pérez. de la Ossa, A. García-Pas-tor, J. F. Arenillas, T. Segura, C. Jiménez Hospital Universitari Arnau de Vilanova. UdL. IRBLlleida, Lleida, SPAIN1, Department of Neurology. Hospital San Pedro de Alcántara de Cáceres, Cáceces, SPAIN2, Department of Neurolo-gy. Hospital Universitario Son Dureta., Palma de Mallorca, SPAIN3, Department of Neurology. Hos-pital Universitario Son Dureta., Palma de Mallorca, SPAIN4, Stroke Unit. Department of Neurology. Hospital Universitari Valld’Hebron, Barcelona, SPAIN5, Stroke Center. Department of Neurology. La Paz University Hospital. Autónoma de Madrid University. IdiPAZ Research Institute, Madrid, SPAIN6, Department of Neurology. Hospital ParcTaulí, Sabadell, Sabadell, SPAIN7, Department of Neurology. Hospital de Basurto, Bilbao, SPAIN8, Department of Neurology. Hospital Clínico San Carlos, Madrid, SPAIN9, Department of Neurology. Hospital Universitario Infanta Cristina, Badajoz, SPAIN10, Stroke Unit. Hospital del Mar, Barcelona, SPAIN11, Department of Neurology. Hospital San Pedro de Alcántara de Cáceres, Cáceres, SPAIN12, Department of Neurology. Hospital de la Santa Creu I Sant Pau. Bar-celona, Barcelona, SPAIN13, Stroke Unit. Department of Neurology. Hospital Universitari de Bell-vitge, Hospitalet de Llobregat, SPAIN14, Hospital Universitario Ramón y Cajal, Madrid, SPAIN15 BACKGROUNG: The highest risk of subsequent stroke after a TIA occurs within the first week af-ter the index event. However, the risk of stroke recurrence (SR) remains important durning the first year of follow-up. We studied the temporal pattern and predictors of SR (at 7-day and one-year fol-low- up). METHODS: Between April 2008 and December 2009, we included 1255 consecutive TIA patients from 30 Spanish stroke centers (PROMAPA study). We prospectively recorded clinical character-istics. We also determined the short-term (at 7 days) and late-term (from 8 days to one year) of SR. Etiology was categorized using the TOAST classification RESULTS: Enough information (clinical variables and extracranial vascular imaging) was assessed in 1137 (90.6%) patients. The 7-day stroke risk was 2.6%. 32 (3.0%) patients had a SR after 7-day follow-up. Multiple TIA (HR 3.50, 1.67-7.35, p=0.001) and large artery atherosclerosis (HR 2.51, 1.17-5.37, p=0.018) were independent predictors of early SR, whereas previous stroke (HR 1.40, 1.03-1.92, p=0.034) and coronary heart disease (2.65, 1.28-5.50, p=0.009) were independent pre-dictors of late SR. 80% of SR happened in the same territory of the index TIA at 7-day follow up, whereas only 38% during the late-term follow-up (p<0.001). CONCLUSION: According to our results, the underlying ischemic mechanism may differ in early and late stroke recurrences. We observed different predictors according to the temporal pattern of SR.
Karger_ESC London_2013
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