Aggressive treatment of 'mini-strokes' lowers risk for major stroke

Modern treatment methods applied within 24 hours of symptoms are credited with the risk for secondary stroke being cut in half in a recent study.

By Stephen Feller

WASHINGTON, April 21 (UPI) -- Better and faster use of secondary stroke prevention methods after transient ischemic attacks, or TIAs, helps reduce risk of additional strokes and death, according to researchers involved with an international study.

With the most aggressive care available, researchers at 21 sites around the world cut in half the risk of a second stroke among participants in the five-year study, which is published in the New England Journal of Medicine.


TIAs, often referred to as mini-strokes, involve minor-seeming symptoms such as a momentary slurring or difficulty in speech. Improvements in care include a combination of better preventive measures and faster response when diagnosed.

For the study, a project, researchers recruited 4,789 patients at 61 hospitals outside the United States during the course of 2.5 years. Of these, 78 percent of the patients were treated within 24 hours of symptoms starting.

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The researchers report that one year after TIA, the risk for a cardiovascular event was 6.2 percent and risk of a stroke was 5.1 percent.

The risk of recurrent stroke 2 days, 7 days, 30 days, 90 days and 1 year after treatment was about half what was expected based on previous studies. At 90 days, for example, the researchers report expectations of 12 to 20 percent risk for cardiovascular event or stroke but participants in the new study were at just 3.7 percent risk.


The researchers suggest the improvement can be credited to better and faster implementation of stroke prevention methods; however, there was no comparison group in the study without access to these drugs and procedures.

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Results from the international study appear somewhat ironclad in endorsing more aggressive preventative actions after a mini-stroke; however, Dr. Ralph Sacco and Dr. Tatjana Rundek, both professors of neurology, epidemiology and public health at the University of Miami, caution the limits of populations in the study in an editorial published with it in the New England Journal of Medicine.

All 21 sites where participants received treatment had specialized stroke and TIA units prepared to apply the most advanced methods of care, making the point that systemically implementing standards of treatment can improve care and prevent deaths, the researchers wrote.

"Stroke prevention and treatment have come a long way," wrote Sacco and Rundek. "This study should prompt health care providers and policymakers to make necessary changes in systems of stroke care in order to deliver the most effective care not only to patients with acute stroke, but also to those with a TIA or minor stroke."

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