Short and long-term prognosis after tissue negative transient ischemic attack

Short and long-term prognosis after tissue negative transient ischemic attack | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Short and long-term prognosis after tissue negative transient ischemic attack View ORCID Profile Francisco Purroy , Yhovany Gallego , M Pilar Gil-Villar , Robert Begue , View ORCID Profile Gloria Arque , View ORCID Profile Alejandro Quilez , Jordi Sanahuja , View ORCID Profile Daniel Vazquez-Justes , View ORCID Profile Gerard Mauri doi: https://doi.org/10.1101/2024.02.11.24302667 Francisco Purroy 1 Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida , Lleida ( Spain ) 2 Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida , Lleida, ( Spain ) MD PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Francisco Purroy For correspondence: fpurroygarcia{at}gmail.com Yhovany Gallego 1 Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida , Lleida ( Spain ) 2 Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida , Lleida, ( Spain ) MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site M Pilar Gil-Villar 1 Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida , Lleida ( Spain ) 2 Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida , Lleida, ( Spain ) MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Robert Begue MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Gloria Arque 2 Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida , Lleida, ( Spain ) PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Gloria Arque Alejandro Quilez 1 Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida , Lleida ( Spain ) 2 Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida , Lleida, ( Spain ) MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Alejandro Quilez Jordi Sanahuja 1 Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida , Lleida ( Spain ) 2 Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida , Lleida, ( Spain ) MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Daniel Vazquez-Justes 1 Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida , Lleida ( Spain ) 2 Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida , Lleida, ( Spain ) MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Daniel Vazquez-Justes Gerard Mauri 1 Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida , Lleida ( Spain ) 2 Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida , Lleida, ( Spain ) MD PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Gerard Mauri Abstract Full Text Info/History Metrics Preview PDF ABSTRACT Background Recently, there has been a proposal to retire the concept of transient ischemic attack (TIA) because, in all likelihood, patients experiencing brief episodes of transient brain ischemia without associated cerebral lesions might be exceedingly rare or carry no risk of stroke recurrence (SR). However, only a few observational studies have evaluated the risk of SR exclusively among tissue-negative TIA patients. Our aim was to assess the early and long-term prognosis of consecutive tissue-negative TIA patients attended at an emergency department Methods We carried out a prospective cohort study of consecutive TIA patients with tissue negative TIA from January 2006 to June 2010. All patients underwent diffusion-weighted imaging on MRI (DWI) (4.0 [SD 1.8] days) after the index event. The risk and predictors of SR were determined at 1 year and after a median follow-up time of 6.6 (interquartile range, 5.0-9.6) years. Results A total of 370 patients were included. Previously, 244 patients with positive DWI results and 109 patients without MRI performed were excluded. ABCD2 score>5 was determined in 95 (26.2%) patients. 15 (4.1%) patients suffered SR at 1 year and 18 (4.9%) beyond 1 year. Predictive models for short-term and long-term prognosis were different. Large artery atherosclerosis etiology (Hazard ratio [HR] 3.7 [1.2-11.0]) was the only predictor of 1 year SR. In contrast, male sex (HR 4.17 [95% CI 1.14-15.23]; P=0.031), speech impairment (HR 4.90 [95% CI 1.05-22.93]; P=0.044), and presence of chronic microangiopathy expressed as Fazekas score of 3 (HR 1.84 [95% CI 1.15-2.97]; P=0.012) were predictors of long-term SR follow-up. Conclusion The risk of SR after tissue negative TIA is not insignificant. Predictors of short and long-term prognosis are different. Sex, clinical characteristics at onset, etiology and chronic microangiopathy determine the risk of SR. INTRODUCTION Since the tissue definition of transient ischemic attack (TIA) was established, TIA has been defined as a transient episode of neurological symptoms without evidence of brain infarction 1 . Recently, Recently, there has been a proposal to retire this concept because it is likely that, with the improvement of neuroimaging techniques, patients experiencing brief episodes of transient brain ischemia actually have lesions in the cerebral parenchyma. It is suggested that these patients should be considered stroke patients. Additionally, it is argued that individuals who suffer transient ischemia without any lesions either do not exist or, if they do, are rare and pose no risk of stroke recurrence (SR) 2 . Until the implementation of imaging tests more sensitive to acute ischemia, it is compelling to investigate the SR in diffusion-weighted imaging (DWI) negative patients. However, no observational studies have exclusively determined the risk of stroke recurrence among tissue-negative TIA patients. Large studies that included both tissue-positive and tissue-negative patients identified predictors of early and late stroke recurrence beyond neuroimaging data, such as large-artery atherosclerosis, clinical features, and sex differences 3 - 5 . Our aim was to assess the early and long-term prognosis of consecutive tissue-negative TIA patients who were attended at an emergency department and to identify predictors of SR among these patients. METHODS Data availability statement The corresponding author will consider requests for access to the data reported in this article. Design and study population The methodology of the study has been previously described 4 . Consecutive patients were included from the cohort of patients in the REGITELL registry) 6 . REGITELL registry is a registry-based cohort study conducted from January 2006 to June 2010, involving consecutive TIA patients attended by a stroke neurologist working in the emergency department of a university hospital within the first 24 hours after the onset of symptoms. The registry was designed in compliance Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. 7 . We included patients who experienced a reversible episode of neurological deficit of ischemic origin that completely resolved within 24 hours and exhibited no evidence of acute ischemic lesions in diffusion-weighted imaging (DWI) sequences 1 . In all cases, cranial MRI was conducted within 7 days of symptom onset (4.0[standard deviation, SD 1.8] days) 4 , 6 . Patients were excluded if they had contraindications for cranial MRI or if the procedure could not be performed. The clinical symptom typologies were documented using a standardized form. The symptom duration was confirmed upon admission and reverified on day 7 during the follow-up period. Their respective ABCD2 risk scores (age, blood pressure, clinical features, symptom duration, and diabetes mellitus) 8 were prospectively assessed. Possible but not conclusively diagnosed TIA events were characterized by isolated atypical symptoms, including unsteadiness, diplopia, dysarthria, partial sensory deficit, and unusual cortical vision 9 . Every case was reviewed and prospectively classified by the senior neurologist (FP). Patients underwent initial investigations, including ECG, blood tests, CT brain imaging, and extracranial and intracranial ultrasound imaging 6 . Patients in whom cardiopathy was suspected underwent comprehensive cardiological examinations. The etiological classification of patients was conducted according to the definitions outlined in the ORG 10172 Trial (TOAST). 10 Imaging Analysis Alongside DWI sequences, we incorporated T2-weighted turbo spin-echo, T2-weighted gradient-recalled echo (T2*-GRE), T1-weighted spin-echo, and turbo fluid-attenuated inversion recovery sequences 6 . A neuroradiologist blinded (RB) to the patients’ clinical data determined the presence of white matter lesions using FLAIR sequences on the MRI. He assessed the Fazekas scale score by evaluating both periventricular and deep WM alterations, considering the quantity and size of lesions, and distinguishing between focal or punctate, early confluent, and confluent abnormalities, scoring from 0 (absence of WM lesions) to 3 (presence of diffuse WM lesions) 11 . Additionally, it ascertained the presence of chronic ischemic lesions in FLAIR sequences corresponding to territorial infarcts not suggestive of microangiopathy. The presence of cerebral microbleeds (CMBs) was determined using T2*-GRE. According to consensus criteria, CMBs were defined as homogeneous hypointense lesions located in the gray or white matter, distinguishable from iron or calcium deposits and vessel flow voids 12 . Outcomes and follow-up The primary outcome was the incidence of recurrent ischemic stroke, characterized by the emergence of new focal symptoms or signs accompanied by acute ischemic changes detected on neuroimaging via brain CT or MRI. Recurrent TIAs, defined as new neurological symptoms or deficits lasting less than 24 hours without evidence of new infarction in neuroimaging, were not considered part of the primary outcome 4 . The secondary outcome comprised a composite of major vascular events (MVE). This encompassed acute coronary syndrome defined as myocardial infarction (with or without ST-segment elevation) or unstable angina leading to urgent catheterization, recurrent ischemic stroke, the onset of symptomatic peripheral arterial disease (PAD), and cardiovascular-related fatalities. Cardiovascular deaths included fatal acute coronary syndrome, fatal stroke, fatal intracranial hemorrhage, fatal pulmonary embolism, sudden death, and unexpected or unobserved deaths within 30 days 5 . During the follow-up period, structured clinical visits were conducted by a team of stroke physicians. These visits occurred at specific intervals of 7 days, 3 months, one year, five years, and 10 years. In instances where a patient relocated out of the local area or hospital visits were not feasible, follow-up assessments were carried out via telephone. Moreover, recurrent events and outcomes were actively monitored through an annual review of electronic medical records. Statistical analysis We compared the baseline characteristics, etiology, neuroimaging data, and ABCD2 score 8 between patients with and without SR. Quantitative variables were compared using either Student’s t-test or the Mann-Whitney U test. Qualitative variables were compared using the chi-squared test or Fisher’s exact test in cases where the expected cell frequency was less than 5. We employed a Cox proportional hazards multivariable analysis, incorporating variables with p-values <0.10 from univariate testing, to identify predictors of SR. The cumulative risks of recurrent stroke and MVE during the follow-up were assessed through Kaplan-Meier analysis. Results were censored at the occurrence of the outcome event, patient death, or the conclusion of the follow-up period. For patients with missing information at the 10-year mark, data were censored at the time of their last available follow-up. We conducted a comparison of the risk of SR among patient subgroups, categorized based on the primary identified predictors, utilizing Kaplan-Meier analysis and the log-rank test. All analyses were two-sided. In multivariable analyses, missing data was accounted for as a random effect when fitting the model. The statistical analysis of the data was carried out using the SPSS statistical package, version 25.0. (IBM SPSS, Chicago, IL, USA) and Graphpad software version 6 (San Diego, CA, USA). Standard protocol approvals, registrations, and patient consents Written informed consent or assent from relatives was obtained for all the participants. The study was approved by our local ethics committee: the “Comité d’Etica i Investigació Clínica de l’Hospital Universitari Arnau de Vilanova de Lleida”. RESULTS A total of 771 patients were initially assessed as possible TIA cases. Forty-eight patients were excluded after being diagnosed as mimics. One hundred nine patients (15.1%) out of the remaining 723 were excluded from the analysis as they did not undergo an MRI. Of the 614 patients who underwent DWI, 370 (60.3%) did not exhibit acute ischemic lesions and were thus included in the study. The median (interquartile rate, IQR) follow-up time was 6.6 (5.2-9.7) years. Thirty-three individuals (8.9%) experienced stroke recurrence: 15 (45.5%) of them during the first year of follow-up and 18 (54.5%) beyond the initial year of follow-up ( figure 1 ). MVE were observed in 47 (12.7%) patients: 22 (46.8%) of them during the first year of follow-up and 25 (53.2%) beyond the initial year of follow-up ( figure 1 ). A total of 111 (30.0) patients died during the follow-up. The median Fazekas score was 0 (IQR: 0-2.0), and an ABCD2 score >5 was present in 95 patients (25.7%) Download figure Open in new tab FIGURE 1 Kaplan-Meier event curves for stroke recurrence and major vascular events according along the entire follow-up Variables associated with stroke recurrence As depicted in Table 1 , various variables are differently associated with early SR within the first year of follow-up and with the risk of SR from the subsequent year of follow-up. Older patients (75.5 [SD: 7.1] vs. 70.2 [SD: 12.1] years; P=0.093), patients with previous atrial fibrillation (11.1% vs. 3.3%; P=0.024) and those with a large artery atherosclerosis subtype etiology (10.2% vs. 2.9%; P=0.009). were associated with early SR within the first year of follow-up. Conversely, patients with diabetes mellitus (9.8% vs. 3.3%; P=0.021), ABCD2 score >5 (12.3% vs. 3.1%; P=0.003), and a Fazekas score of 3 (11.0% vs. 3.7%; P=0.057) were associated with SR from the subsequent year of follow-up. In the subsequent year of follow-up, women had a lower risk of stroke (2.7% vs. 7.2%; P=0.076). Ultimately, patients experiencing speech impairment during the index event were associated with stroke recurrence throughout the entire follow-up period (5.6% vs. 1.4%; P=0.050 and 7.5% vs. 1.5%; P=0.020). View this table: View inline View popup Table 1 Baseline characteristics, etiology and neuroimaging findings by stroke recurrence Predictors of stroke recurrence SR during the first year of follow-up was significantly associated with large artery atherosclerosis etiology (hazard ratio [HR] 3.67 [95% CI, 1.22–11.04]; P=0.021). Conversely, stroke recurrence beyond the initial year of follow-up was linked to male sex (HR 4.17 [95% CI 1.14-15.23]; P=0.031), speech impairment (HR 4.90 [95% CI 1.05-22.93]; P=0.044), and a Fazekas score of 3 (HR 3.36 [95% CI 1.12-10.11]; P=0.031) ( Table 2 ). View this table: View inline View popup Download powerpoint Table 2 Follow-up events View this table: View inline View popup Download powerpoint Table 3. Cox proportional hazards regression model to assess risk of subsequent stroke after transient ischemic attack, considering time-periods of follow-up In the Kaplan-Meier analysis ( Figure 2 ), an undetermined etiology was associated with the lowest risk of stroke recurrence throughout the follow-up period, whereas LAA was associated with a higher risk of stroke recurrence during the first year (P=0.077). The risk of SR trend to remained elevated in those patients with a Fazekas score of 3 from the first to the second year of follow-up (P=0.051). Similarly, patients with ABCD2 scores >5 maintained a heightened risk, especially from the second year of follow-up onwards (P=0.013). The risk of SR remained similar between both sexes during the first three years, later tending to be higher in male patients (P=0.051). Finally, patients with speech impairment have a higher risk of stroke recurrence throughout the entire follow-up (P=0.001). Download figure Open in new tab FIGURE 2 Kaplan-Meier event curves for stroke recurrence according to TOAST etiology (A), Fazekas scale (B), sex (C), ABCD2 score (D) and speech impairment (E) DISCUSSION In a cohort of patients with TIA, based on tissue definition, we observed that the risk of stroke recurrence, although lower than expected for patients with minor stroke or abnormal DWI TIA 3 - 5 , 13 , is not negligible, affecting nearly one in ten patients. Thus, the underestimation of the risk of SR in those patients with episodes compatible with TIA and normal DWI, as well as the trivialization of the concept of TIA, needs to be approached with caution 2 . According to our results, it is essential to consider that there are variables that determine the risk of recurrence differently throughout the follow-up. In our study, similar to previous research that included patients with transient clinical symptoms regardless of DWI results, as well as those with minor strokes, atheromatous etiology 3 - 5 was linked to more than threefold increase in the risk of stroke recurrence during the first year. Beyond the one-year follow-up, non-modifiable risk factors such as gender, the presence of chronic microangiopathy, and certain clinical characteristics identified at the time of the episode become relevant. In line with previous studies, we observed a higher recurrence risk among male patients 4 , 14 - 16 . These differences could be attributed to a higher accumulation of vascular risk factors among men compared to women 4 , 16 . Interestingly, we observed an association between the presence of white matter hyperintensities (WMH) or leukoaraiosis, particularly when they are extensive and reach Fazekas grade 3, and SR. Previously, it has been described how the burden of chronic white matter lesions was associated with short-term outcomes 17 and long-term SR 18 . WMH are a common neuroimaging feature of cerebral microangiopathy 19 . A higher rate of extended WMH is strongly associated with SR in all stroke subtypes, even after adjustment for clinical risk factors 20 . Some previous studies have also been focused on TIA patients. Ren et al. demonstrated a correlation between WMH and SR, which can be attributed to arteriosclerotic narrowing, plaque, artery stiffening, small vessel disease, hemodynamic injury, and impaired autoregulation 21 . Furthermore, we observed the relevance of the clinical characteristics of the index episode in identifying patients at higher risk of recurrence. Thus, there was an association between high scores on the ABCD2 scale and SR during advanced follow-up. Unlike TIA studies that do not consider tissue definition, language impairment has assumed a more prominent role than motor impairments or the presence of multiple episodes in our investigation 22 . It is possible that these characteristics are linked to a higher likelihood of acute ischemic lesions on DWI 23 . Hence, such patients would be excluded in our series. It can be highlighted that none of the patients with isolated sensory symptoms experienced a SR. Our study has certain limitations that need to be highlighted. On one hand, it is essential to consider that this is a single-center study, which poses a limitation in terms of sample size. On the other hand, we must acknowledge that the analysis of WMH has been qualitative rather than quantitative, although there are studies that have addressed both approaches simultaneously without significant differences between them 17 , 24 . The risk of SR following a tissue-negative TIA is noteworthy. Predictors for short and long-term prognosis vary, with sex, initial clinical characteristics, etiology and WMH being determinants of the SR risk. The risk of SR after a tissue-negative TIA is of significant concern. Predictors influencing short and long-term prognosis are multifaceted, including sex, initial clinical characteristics, etiology, and the presence and extension of WMH, all of which serve as determining factors for the SR risk at different stages during follow-up. Thus, there should be a reinforcement of the therapeutic and organizational management for patients who have experienced a tissue-negative TIA of atheromatous etiology to prevent recurrences during the initial year of follow-up. Additionally, for those patients exhibiting elevated scores on the ABCD2 scale and extensive white matter lesions, particular emphasis should be placed on averting long-term recurrences. Contributions FP conceived the study and procured the funding FP, YG, MPGV, GM, AQ, JS, DVJ, were involved in the recruitment and follow-up of patients FP wrote the paper. FP and GM substantively revised the manuscript All the authors revised and approved the final manuscript Sources of Funding This study was supported by the Catalan Autonomous Government’s Agència de Gestió d’Ajuts Universitaris i de Recerca (2021 suport a les activitats dels grups de recerca 1479) and the Instituto de Salud Carlos III, (08/1398, 11/02033 and 14/01574) and the RICORS Research Network. Declaration of conflicting interests The authors declare no conflicts of interest regarding research, authorship, and/or the publication of this article Footnotes The authors declare no conflicts of interest Non-standard Abbreviations and Acronyms AF atrial fibrillation DWI diffusion weighted imaging HR hazard ratio LAA large artery atherosclerosis MVE major vascular events SR stroke recurrence WMH white matter hyperintensities REFERENCES 1. ↵ Easton JD , Saver JL , Albers GW , Alberts MJ , Chaturvedi S , Feldmann E , Hatsukami TS , Higashida RT , Johnston SC , Kidwell CS , et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. 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Share Short and long-term prognosis after tissue negative transient ischemic attack Francisco Purroy , Yhovany Gallego , M Pilar Gil-Villar , Robert Begue , Gloria Arque , Alejandro Quilez , Jordi Sanahuja , Daniel Vazquez-Justes , Gerard Mauri medRxiv 2024.02.11.24302667; doi: https://doi.org/10.1101/2024.02.11.24302667 Share This Article: Copy Citation Tools Short and long-term prognosis after tissue negative transient ischemic attack Francisco Purroy , Yhovany Gallego , M Pilar Gil-Villar , Robert Begue , Gloria Arque , Alejandro Quilez , Jordi Sanahuja , Daniel Vazquez-Justes , Gerard Mauri medRxiv 2024.02.11.24302667; doi: https://doi.org/10.1101/2024.02.11.24302667 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Neurology Subject Areas All Articles Addiction Medicine (573) Allergy and Immunology (865) Anesthesia (302) Cardiovascular Medicine (4454) Dentistry and Oral Medicine (444) Dermatology (383) Emergency Medicine (610) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1515) Epidemiology (15244) Forensic Medicine (30) Gastroenterology (1131) Genetic and Genomic Medicine (6617) Geriatric Medicine (669) Health Economics (1002) Health Informatics (4554) Health Policy (1372) Health Systems and Quality Improvement (1614) Hematology (543) HIV/AIDS (1270) Infectious Diseases (except HIV/AIDS) (15931) Intensive Care and Critical Care Medicine (1106) Medical Education (624) Medical Ethics (147) Nephrology (670) Neurology (6626) Nursing (346) Nutrition (999) Obstetrics and Gynecology (1148) Occupational and Environmental Health (957) Oncology (3345) Ophthalmology (980) Orthopedics (369) Otolaryngology (421) Pain Medicine (436) Palliative Medicine (130) Pathology (665) Pediatrics (1696) Pharmacology and Therapeutics (693) Primary Care Research (714) Psychiatry and Clinical Psychology (5462) Public and Global Health (9253) Radiology and Imaging (2207) Rehabilitation Medicine and Physical Therapy (1371) Respiratory Medicine (1197) Rheumatology (597) Sexual and Reproductive Health (715) Sports Medicine (530) Surgery (714) Toxicology (99) Transplantation (289) Urology (265) (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'a030050fdafe1b23',t:'MTc4MDAwMDI1Mw=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();