Recurrent Ischemic Stroke - A Systematic Review and Meta-Analysis.
Aged
Aged, 80 and over
Cerebral Small Vessel Diseases
/ diagnosis
Comorbidity
Embolic Stroke
/ diagnosis
Female
Humans
Intracranial Arteriosclerosis
/ diagnosis
Ischemic Stroke
/ diagnosis
Male
Middle Aged
Prevalence
Prognosis
Recurrence
Risk Assessment
Risk Factors
Secondary Prevention
Time Factors
Secondary prevention
Stroke recurrence
Stroke subtype
TOAST-criteria
Journal
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
ISSN: 1532-8511
Titre abrégé: J Stroke Cerebrovasc Dis
Pays: United States
ID NLM: 9111633
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
received:
06
03
2021
revised:
20
05
2021
accepted:
29
05
2021
pubmed:
22
6
2021
medline:
27
7
2021
entrez:
21
6
2021
Statut:
ppublish
Résumé
Recurrent stroke remains a challenge though secondary prevention is initiated immediately post-stroke. Stroke subtype may determine the risk of recurrent stroke and require specific preventive measures. We aimed to identify subtype-specific stroke recurrence and associated risk factors over time. A systematic review was performed using PubMed and Embase for studies including adults >18 years, first-ever ischemic stroke in population-based observational studies or registries, documented TOAST-criteria and minimum 1-year follow-up. Meta-analysis on stroke recurrence rate was performed. Final search: November 2019. The search retrieved 26 studies (between 1997 and 2019). Stroke recurrence rate ranged from 5.7% to 51.3%. Recurrent stroke was most frequent in large artery atherosclerosis (LAA) and cardioembolic (CE) stroke with recurrent stroke similar to index stroke subtype. We identified a lower recurrence rate for small vessel occlusion (SVO) stroke with recurrence frequently of another stroke subtype. Based on a meta-analysis the summary proportion recurrence rate of recurrent stroke in studies using TOAST-criteria = 0.12 and = 0.14 in studies using TOAST-like criteria. Hypertension, diabetes mellitus, atrial fibrillation previous transient ischemic attack, and high stroke severity were independent risk factors for recurrence. Stroke recurrence rates seem unchanged over time despite the use of secondary prevention. The highest recurrence rate is in LAA and CE stroke eliciting same subtype recurrent stroke. A lower recurrence rate is seen with SVO stroke with a more diverse recurrence pattern. Extensive workup is important in all stroke subtypes - including SVO stroke. Future research needs to identify better preventive treatment and improve compliance to risk factor prevention to reduce stroke recurrence.
Identifiants
pubmed: 34153594
pii: S1052-3057(21)00338-4
doi: 10.1016/j.jstrokecerebrovasdis.2021.105935
pii:
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
105935Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest None.