PMID- 7872876
OWN - NLM
STAT- MEDLINE
DCOM- 19950324
LR  - 20190717
IS  - 0003-9942 (Print)
IS  - 0003-9942 (Linking)
VI  - 52
IP  - 3
DP  - 1995 Mar
TI  - The risk of stroke in patients with first-ever retinal vs hemispheric transient 
      ischemic attacks and high-grade carotid stenosis. North American Symptomatic 
      Carotid Endarterectomy Trial.
PG  - 246-9
AB  - BACKGROUND: The prognosis of amaurosis fugax has been considered to be favorable 
      compared with that of hemispheric transient ischemic attacks. However, this has 
      remained uncertain for patients with significant carotid stenosis as the 
      assessment of progression of the disease has been confounded when patients 
      undergo carotid endarterectomy. In the North American Symptomatic Carotid 
      Endarterectomy Trial, patients with high-grade (70% to 99%) carotid stenosis were 
      randomized to receive either medical or surgical treatment, thus making an 
      unconfounded analysis possible. METHOD: We identified 129 medically treated 
      patients with high-grade carotid stenosis who had their first-ever transient 
      ischemic attack as the entry event into the trial. Fifty-nine patients with 
      retinal transient ischemic attacks (RTIAs) were compared with 70 patients with 
      hemispheric transient ischemic attacks (HTIAs). RESULTS: Patients with HTIAs were 
      older, with a higher prevalence of most risk factors for stroke. Average time of 
      delay from the onset of transient ischemic attacks to medical treatment was 
      longer for patients with RTIAs than for patients with HTIAs (48.5 vs 15.2 days). 
      Kaplan-Meier estimates of the risk of ipsilateral stroke at 2 years were 16.6% 
      +/- 5.6% for patients with RTIAs and 43.5% +/- 6.7% for patients with HTIAs (P = 
      .002 for the difference in risk between RTIAs and HTIAs). From corresponding 
      Cox's proportional hazards regression analyses, the risk of ipsilateral stroke 
      ranged from 11.2% to 28.9% for patients with RTIAs and from 37.4% to 96.3% for 
      patients with HTIAs across stenoses, spanning 75% to 95%. Overall, the relative 
      risk of ipsilateral stroke (HTIAs compared with RTIAs) was 3.23 (95% confidence 
      interval, 1.47 to 7.12), regardless of the degree of high-grade stenosis. 
      CONCLUSION: To our knowledge, this study is the first report on the expected 
      outcome for medically treated patients with high-grade (70% to 99%) carotid 
      stenosis in whom the first-ever event was either an RTIA or HTIA. The presence of 
      RTIAs carries a considerable risk of ipsilateral strokes, particularly at higher 
      degrees of stenosis. However, in comparison with HTIAs, patients with RTIAs still 
      have a better prognosis.
FAU - Streifler, J Y
AU  - Streifler JY
AD  - Department of Clinical Neurological Sciences, University of Western Ontario, 
      London.
FAU - Eliasziw, M
AU  - Eliasziw M
FAU - Benavente, O R
AU  - Benavente OR
FAU - Harbison, J W
AU  - Harbison JW
FAU - Hachinski, V C
AU  - Hachinski VC
FAU - Barnett, H J
AU  - Barnett HJ
FAU - Simard, D
AU  - Simard D
LA  - eng
GR  - R01-NS-24456/NS/NINDS NIH HHS/United States
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Arch Neurol
JT  - Archives of neurology
JID - 0372436
SB  - IM
CIN - Arch Neurol. 1996 Apr;53(4):294-5. PMID: 8929149
MH  - Aged
MH  - Carotid Stenosis/*complications/surgery
MH  - Cerebrovascular Disorders/epidemiology/*etiology
MH  - Endarterectomy
MH  - Female
MH  - Humans
MH  - Ischemia/*complications
MH  - Ischemic Attack, Transient/*complications
MH  - Male
MH  - Middle Aged
MH  - Randomized Controlled Trials as Topic
MH  - Retinal Diseases/*complications
MH  - Risk Factors
EDAT- 1995/03/01 00:00
MHDA- 1995/03/01 00:01
CRDT- 1995/03/01 00:00
PHST- 1995/03/01 00:00 [pubmed]
PHST- 1995/03/01 00:01 [medline]
PHST- 1995/03/01 00:00 [entrez]
AID - 10.1001/archneur.1995.00540270034016 [doi]
PST - ppublish
SO  - Arch Neurol. 1995 Mar;52(3):246-9. doi: 10.1001/archneur.1995.00540270034016.