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From the Department of Neurology (Drs. Moncayo, de Freitas, Bogousslavsky, and Altieri), Centre Hospitalier Universitaire Vaudois; and the University Institute of Social and Preventive Medicine (Dr. van Melle), Lausanne, Switzerland.
Address correspondence and reprint requests to Dr. Julien Bogousslavsky, Department of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV), CH 1011, Lausanne, Switzerland.
OBJECTIVE: To determine whether TIAs have a neuroprotective effect.
BACKGROUND: Ischemic tolerance or preconditioning, which protects the brain against stroke, has been demonstrated in animal models of cerebral ischemia. Because TIA may represent a clinical model of ischemic tolerance, patients with TIA before cerebral infarction (CI) may therefore have a better outcome than patients without TIA before CI.
METHODS: A total of 2,490 patients admitted consecutively to a primary care center for first-ever CI in the anterior circulation were divided into two groups on the basis of the presence or absence of prior ipsilateral TIAs. Duration of TIA was classified into three groups (<10 minutes, 10 to 20 minutes, and >20 minutes). The severity of the neurologic picture on admission and functional disability after stroke were compared between patients with and without TIAs.
RESULTS: A total of 293 (12%) of the 2,490 patients had prior ipsilateral TIAs before CI. Risk factors did not differ between patients with or without TIAs, whereas the topography and etiology of ischemic stroke did differ (p < 0.001). Patients without prior TIAs had a more severe clinical picture on admission, with a greater reduction of consciousness (p = 0.009). Patients with previous TIAs had a more favorable outcome than those without TIAs (67% versus 58%, p = 0.004). After adjustment for confounding variables, TIAs lasting 10 to 20 minutes were still associated with a favorable outcome (odds ratio, 1.98; 95% confidence interval, 1.27 to 3.08; p = 0.002). The interval between TIA and CI influenced the outcome (p = 0.007).
CONCLUSIONS: This study suggests that ischemic tolerance may play a role in patients with ipsilateral TIAs before CI, allowing better recovery from a subsequent ischemic stroke.
Key words: Cerebrovascular disorders—Ischemic stroke—Ischemic tolerance—Ischemic preconditioning—Transient ischemic attack—Prognosis.
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