Transient ischemic attacks and small strokes. Modern therapeutic strategies
https://doi.org/10.26295/OS.2020.56.70.001
Abstract
Transient ischemic attacks (TIA) are a strong predictor not only of acute cerebral circulatory disorders, but also of other vascular events, including acute coronary syndrome and arterial thrombosis of other localization. Current clinical guidelines do not distinguish between TIA and small ischemic stroke in terms of treatment strategy. Meanwhile, the high probability of intracranial hemorrhages in patients with small strokes and small artery disease limits the possibility of aggressive therapy in patients with TIA. This contradiction can be resolved if TIA is assessed as an emergency condition similar to acute coronary syndrome. Modern methods of brain imaging solve the problem of differential diagnosis between TIA and small strokes. Aggressive therapy with antiplatelet agents, antihypertensive agents, and statins reduces the likelihood of fatal vascular events in patients with TIA.
About the Authors
E. A. Shirokov
ФГБВОУ ВО ВМА им. С. М. Кирова Минобороны РФ
Russian Federation
Russian Federation
V. B. Simonenko
ФГБВОУ ВО ВМА им. С. М. Кирова Минобороны РФ
Russian Federation
Russian Federation
Yu. V. Ovchinnikov
ФГБВОУ ВО ВМА им. С. М. Кирова Минобороны РФ
Russian Federation
Russian Federation
References
1. Amarenco P., Lavall?e C., Monteiro Tavares L. Five-Year Risk of Stroke after TIA or Minor Ischemic Stroke // New Eng Journal of medicine. Published on May 16, 2018, at NEJM.org. DOI: 10.1056/NEJMoa1802712.
2. Giles M. F., Albers G. W., Amarenco P. et al. Early stroke risk and ABCD2 score performance in tissue - vs time defined TIA // Neurology. 2011; 77: 1222-1228.
3. Uchiyama S., Amarenco P., Minematsu K. et al. TIA as Acute Cerebrovascular Syndrome // Front Neurol Neurosci. 2014, vol. 33, p. 135-146. DOI: 10.1159/000351914.
4. Симоненко В. Б., Широков Е. А., Фролов В. М. Клиническая кризология в кардионеврологии. М.: Издательство КВОРУМ, 2013. 293 с.
5. Kernan W. N., Ovbiagele B., Black H. R. et al. Guidelines for the Primary Prevention of Stroke: A Statement for Healthcare Professionals from the American Heart Association/American Stroke Association // Stroke. 2014; 45: 2160-2236.
6. Парфенов В. А., Хасанова Д. Р. Ишемический инсульт. М.: Издательство «Медицинское информационное агентство», 2012.
7. Bae H. J., Yoon B. W., Kang D. W., Koo J. S., Lee S. H., Kim K. B. et al. Correlation of coronary and cerebral atherosclerosis: difference between extracranial and intracranial arteries // Cerebrovasc Dis. 2006; 21: 112-119.
8. Agusti A., Bel E., Thomas M. et al. Treatable traits: toward precision medicine of chronic airway diseases // Eur Respir J. 2016; 47: 410-419. DOI: 10.1183/13993003.01359-2015.
9. Jameson J. L., Longo D. L. Precision medicine - personalized, problematic, and promising // N Engl J Med. 2015; 372: 2229-2234.
10. Mozaffarian D., Benjamin E., Go A. et al. Heart Disease and Stroke Statistics - 2016 Update // Circulation. 2016; 133 (4): e38-e360.
11. Roffi M., Patrono C., Collet J. P., Mueller C. et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC) // Eur Heart J. 2016; 37 (3): 267-315.
12. Widimsky P., Coram R., Abou-Cheb A. Reperfusion therapy of acute ischaemic stroke and acute myocardial infarction: similarities and differences // European Heart Journal. 2014; 35: 147-155.
13. Mok V., Kim J. Prevention and Management of Cerebral Small Vessel Disease // Journal of Stroke. 2015; 17 (2): 111-122.
14. Dolmans L. S., Hoes A., Bartelink E. et al. Patient delay in TIA: a systematic review // Jornal of Neurology. 2018. DOI: 10.1007/s00415-018-8977-6.
15. Lavall?e P., Amarenco P. Stroke Subtypes and Interventional Studies for Transient Ischemic Attack. TIA as Acute Cerebrovascular Syndrome // Front Neurol Neurosci. 2014; 33: 135-146. DOI: 10.1159/000351914.
16. Chen Z. M., Sandercoch P., Pan H. C. et al. Indication for early aspirin use in acute ischemic stroke. A combined analysis of 40 000 randomized patients from the Chines Acute Stroke Trial and the International Stroke Trial // Stroke. 2000; 31: 1240-1249.
17. Kennedy J., Ryckborst K. et al. For the FASTER investigators: Fast Assessment of Stroke and Transient Ischemic Attack to prevent Early Recurrence (FASTER): a randomized controlled pilot trial // Lancet Neurol. 2007; 6: 961-969.
18. Powers W., Rabinstein A., Ackerson T. et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association // Stroke. 2018; 49: eXXX-eXXX. DOI: 10.1161/STR.0000000000000158.
19. Prasad K., Siemieniuk R., Hao Q. Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke: a clinical practice guideline // BMJ. 2018; 363: k5130. DOI: 10.1136/bmj.k5130 (published 18 December 2018).
20. Sandercock P., Counsell C., Tseng M. C., Cecconi E. Oral antiplatelet therapy for acute ischemic stroke // Cochrane Database of Systematic Reviews. 2014, Issue 3. Art. №: CD000029. DOI: 10.1002/14651858.CD000029.pub3.
21. Li Z., Wang Y., Zhao X. et al. Treatment effect of clopidogrel plus aspirin within 12 hours of acute minor stroke or transient ischemic attack // J Am Heart Assoc. 2016; 5: e003038. DOI: 10/1161/JAHA.115.003038.
22. Sharma V. K., Tan B. Y., Ying Sim M. Y. Rationale and design of a randomized trial of early intensive blood pressure lowering on cerebral perfusion parameters in thrombolysed acute ischemic stroke patients // Medicine. 2018, 97: 40 (e12721). doi.org/10.1097/MD.0000000000012721.
23. Симоненко В. Б., Широков Е. А., Овчинников Ю. В. Клинические особенности течения артериальной гипертонии, осложненной перенесенным ишемическим инсультом // Клиническая медицина. 2007; 85 (9): 45-49.
24. Powers W. J. Acute hypertension after acute stroke: the scienti?c basis for treatment decisions // Neurology. 1993; 43: 461-467.
25. Fischberg G. M., Lozano E., Rajamani K. et al. Stroke precipitated by moderate blood pressure reduction // J Emerg Med. 2000; 19: 339-346.
26. Anderson C. S., Huang Y., Lindley R. I. et al. Intensive blood pressure reduction with intravenous thrombolysis therapy for acute ischaemic stroke (ENCHANTED): an international, randomised, open-label, blinded-endpoint, phase 3 trial. Published Online February 7, 2019. http://dx.doi.org/10.1016/ S0140-6736(19)30038-8.
27. Skalidi S. J., Manios E. D., Stamatelopoulos K. S. et al. Brain edema formation is associated with the time rate of blood pressure variation in acute stroke patients // Blood Press Monit. 2013; 18 (4): 203-207.
28. Фонякин А. В., Гераскина Л. А. Профилактика ишемического инсульта. Рекомендации по гиполипидемической терапии. М.: ИМАПРЕСС, 2015. 60 с.
29. Pan Y. Outcomes Associated With Clopidogrel-Aspirin Use in Minor Stroke or Transient Ischemic Attack. Published online August 19, 2019. DOI: 10.1001/jamaneurol.2019.2531.
Review
For citations:
Shirokov E.A., Simonenko V.B., Ovchinnikov Yu.V. Transient ischemic attacks and small strokes. Modern therapeutic strategies. Lechaschi Vrach. 2020;(5):7. (In Russ.) https://doi.org/10.26295/OS.2020.56.70.001
Views:
308
JATS XML
Email this article 
