Forward-looking TIA Clinical Follow-up Study

Objective: Transient ischemic attack (TIA) is one of the dangerousfactors for cerebral infarction. It will occur on about12-20%of the cerebralinfarction patients. Globally speaking, incidence of cerebral infarction andTIA is increasing year by year. TIA is a super prewarning signal of ischemicstroke, as well as one of the emergencies in neurology. In the first90daysafter TIA onset, over10%patients have to face the risk of being attacked bystroke,especially in the first2days. The general risk of TIA recurrence,myocardial infarction and death in this3months is as high as25%. Apart fromcerebral infarction, risk of myocardial infarction and sudden death is also veryhigh for TIA patients.Major dangerous factors contributing to TIA include: gender, age, race,family hereditary diseases, hypertension, heart disease, diabetes, smoking,excessive drinking, dyslipidemia, anemia, carotid artery stenosis, metabolicsyndrome, hyperhomocysteinemia,lack of physical exercise, unreasonablefood nutrition and intake, etc. Studies show that dangerous factors of strokesoon after TIA are onset time>10minutes, age>60, existance ofhemispheric ischemic symptoms (weakness and dysarthria), etc) as well asdiabetes. Risk of stroke in90days after the TIA for patients with the abovedangerous factors is10.9%. Therefore, we should conduct prediction and rapidrisk stratification to TIA patients on the early stage and provide activetreatments to lessen the risk of stroke after TIA, improve patients' life qualityand reduce financial burden to their families and the society.Main methods of stroke after TIA prediction are SPI-I, SPI-II, Californiascoring, ABCD scoring, as well we ABCD2scoring proposed by Johnstonand other person. Currently, the7-mark ABCD2scoring system proposed byJohnston is the common used method to evaluate prognosis of TIA. ABCD2scoring system is an objective evaluation of the risk of cerebral infarction after TIA, as well as a comparatively comprehensive summary of dangerous factorscontributing to cerebral infarction after TIA. It provides certain objectiveevaluation basis to doctors for treatment of TIA patients, and has certainclinical application value.This project aims at carrying out clinical follow-up study to123TIApatients to explore the relationship between dangerous factors of TIA and thesecondary cerebral infarction, thus providing basis for clinical treatment andprevention of secondary cerebral infarction after TIA.Methods: Choose123TIA patients as study objects and make a detailedrecord of their basic information, including age, gender, history of smoking,history of drinking, previous medical history of hypertension, coronary heartdisease and diabetes as well as family history of cerebrovascular disease,clinical symptoms, duration, onset frequency, imageing data (CT or MRI),blood fat, etc. Then conduct follow-ups through phonecalls or outpatientservices respectively on the first, the third and the twelfth month after they arechosen as objects, asking them their drug use situation, whether they havegotten rid of smoking and drinking, as well as whether there is any occurrenceof cerebral infarction. This project will be terminated when a newcerebrovascular disease shows up or the patient dies.Results: There are126patients satisfying requirements during thisproject, among whom3are lost to follow-up due to telephone change.Statistical analysis of the rest123patients are as follows: total123patients(age22-80, average59.24±12.312), including88males (age22-80, average57.22±12.610), and35females (age46-77, average64.31±9.996); as forclinical manifestation,97of them (78.9%) have problems of internal carotidsystem. Out of this97patients,43of them have symptoms of single-side lambweakness;19of them, single-side lamb weakness together with numbness;15of them, single-side lamb weakness together with dysarthria;12of them,dysarthria; and8of them, single-side lamb paraesthesia. The rest26patientshave problems of vertebrobasilar system. Main symptoms of these patients aredizziness, vertigo, diplopia, limb weakness, etc. 22out of the123patients develop into cerebral infarction within1year andthe cerebral infarction rate on the first month, the third month and the twelfthmonth after TIA is10.6%,15.4%and17.9%respectively. Analysis has beenconducted on relationship between incidence of cerebral infarction on TIApatients within1year and factors including gender, age, hypertension,diabetes, medical history of coronary heart disease, family history ofcerebrovascular disease, onset time, onset frequency, smoking, drinking andclinical symptoms. Single factor analysis shows that meaningful influencingfactors of incidence of cerebral infarction on TIA patients within1yearinclude age>60, medical history of hypertension and diabetes, as well asonset times>3(p<0.05); multi-factor logistic regression analysis shows thatthe four factors of age>60, medical history of hypertension, medical historyof diabetes, as well as onset times>3are the dangerous factors of TIApatients' development into cerebral infarction within1year, p<0.05). TheseTIA patients can be divided into three groups as low-risk (≤3marks),medium-risk (>4-5marks), and high-risk (>5marks) in accordance with theABCD2scoring results.6out the66TIA patients in low-risk group areattacked by cerebral infarction (9.1%);14out of the52TIA patients inmedium-risk group are attacked by cerebral infarction (26.9%) and2out ofthe5TIA patients in high-risk group are attacked by cerebral infarction (40%),that is, incidence rate of cerebral infarction within1year after TIA of the threegroups is9.1%,26.9%and40%respectively and these differences havestatistical significance (x2=8.032,p＜0.05).Conclusions:1Cerebral infarction incidence rate on the first month, the third month and thetwelfth month after TIA are10.6%,15.4%and17.9%respectively.2Dangerous factors that make TIA develop into cerebral infarction within1year include: age>60, medical history of hypertension and diabetes, as wellas onset frequency>3.3The ABCD2scoring system has a better prediction on secondary cerebralinfarction after TIA. The higher the score is, the higher the risk of secondary cerebral infarction is.