In a prospective study, 15% of patients had not recovered full functioning 3 months after transient ischemic attack or minor ischemic stroke.
Most randomized trials of thrombolytic therapy for acute ischemic stroke have excluded patients with minor neurological deficits. A substantial proportion of these patients leave the hospital with some form of disability, but whether that disability persists in the long term remains uncertain. To address this uncertainty, researchers conducted a prospective observational study to ascertain 3-month functional outcomes in patients with transient ischemic attack (TIA) or minor stroke.
The CATCH study enrolled 510 patients with high-risk TIA (focal weakness or speech dysfunction lasting 5 minutes) or minor ischemic stroke (NIH Stroke Scale [NIHSS] score 3). Patients who received thrombolysis or had preexisting disability were excluded. All patients underwent baseline computed tomographic (CT) angiography.
Among 499 patients with complete follow-up, 15% had disability (modified Rankin Scale [mRS] score 2) at 3 months. Twenty-six percent of these patients had a recurrent ischemic event; in the remaining 74%, long-term disability presumably resulted from the original event. Disability rates ranged from 7% among patients with a baseline NIHSS score of zero, to 22% among those with a score of 3. In patients without recurrent events, disability was predicted by ongoing symptoms at the time of evaluation (odds ratio, 2.4) and large-vessel occlusion or acute infarction on CT angiography (OR, 2.4). These predictive associations were also significant when patients with recurrent events were included.
Comment: The authors justifiably call for more research into why patients without recurrent events end up with disability, particularly when there are no apparent deficits at baseline. In the meantime, this study should motivate us to ensure adequate follow-up and rehabilitation for patients with seemingly minor ischemic events. Additionally, these results support the use of thrombolytic therapy for minor ischemic stroke, and they help make a case for acute-treatment trials in this population.
Source:Journal Watch Neurology