BACKGROUND Recent prospective registration studies of transient ischemic attack in Western countries demonstrated that large artery atherosclerosis is the highest risk etiology for early stroke recurrence under urgent evaluation and treatment. On the other hand, some limited transient ischemic attack studies from East Asian countries showed transient ischemic attack patients due to small vessel occlusion were at a higher early stroke risk. AIMS We aimed to assess the risk for early stroke in small vessel occlusion-transient ischemic attack patients in a Japanese large transient ischemic attack registry. METHODS We analyzed the data of a prospective Japanese transient ischemic attack registry including 1320 transient ischemic attack patients within seven days after onset. Small vessel occlusion-transient ischemic attack was defined as the presence of lacunar transient ischemic attack syndrome, without other etiologies. The outcome measure was recurrent stroke within 30 days after transient ischemic attack. The predictors of 30-day recurrent stroke were estimated using the Cox proportional hazards model. RESULTS The study population had a mean age of 69 ± 12 years and 470 were women. Recurrent stroke was observed in 61 patients (4.6%), and the highest rate was observed with small vessel occlusion-transient ischemic attack (7.8%), followed by large artery atherosclerosis (5.4%). In multivariate analysis, recurrent stroke was independently associated with small vessel occlusion-transient ischemic attack (hazard ratio (HR): 2.01, 95% confidence interval (CI): 1.19-3.35), higher systolic blood pressure (HR: 1.18, 95% CI: 1.08-1.28), and presentation within 3 h after onset (HR: 2.21, 95% CI: 1.27-4.04). Furthermore, small vessel occlusion-transient ischemic attack with acute small deep infarct on diffusion-weighted imaging was a stronger predictor of recurrent stroke (HR: 4.87, 95% CI: 2.09-10.0). CONCLUSION Small vessel occlusion-transient ischemic attack, especially with acute small deep infarct, had a higher early stroke risk compared with other etiologies in Japanese transient ischemic attack patients who received early management.

中文翻译：

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小血管闭塞是短暂性脑缺血发作后早期复发性中风的高危病因。

背景技术西方国家近期对短暂性脑缺血发作的前瞻性登记研究表明，在紧急评估和治疗下，大动脉粥样硬化是中风早期复发的最高风险病因。另一方面，来自东亚国家的一些有限的短暂性脑缺血发作研究表明，由于小血管闭塞引起的短暂性脑缺血发作患者处于较高的早期卒中风险中。目的我们旨在评估日本大型短暂性脑缺血发作登记处的小血管闭塞性短暂性脑缺血发作患者早期卒中的风险。方法我们分析了前瞻性日本短暂性脑缺血发作登记资料，包括发病后7天内的1320例短暂性脑缺血发作患者。小血管阻塞短暂性脑缺血发作定义为存在腔隙性短暂性脑缺血发作综合征，无其他病因。结果指标是短暂性脑缺血发作后30天内复发性中风。使用Cox比例风险模型估算30天复发性中风的预测因子。结果研究人群的平均年龄为69±12岁，其中470位为女性。在61例患者中观察到复发性中风（4.6％），在小血管阻塞-短暂性脑缺血发作中观察到的发生率最高（7.8％），其次是大动脉粥样硬化（5.4％）。在多因素分析中，复发性中风与小血管闭塞性短暂性脑缺血发作独立相关（危险比（HR）：2.01，95％置信区间（CI）：1.19-3.35），较高的收缩压（HR：1.18，95％CI：1.08-1.28），并在发病后3小时内出现（HR：2.21，95％CI：1.27-4.04）。此外，弥散加权成像对急性小深部梗死的小血管阻塞短暂性脑缺血发作是复发性卒中的更强预测因子（HR：4.87，95％CI：2.09-10.0）。结论与接受早期治疗的日本短暂性脑缺血发作患者相比，小血管阻塞性短暂脑缺血发作（尤其是急性小面积深层梗死）的早期卒中风险高于其他病因。