TY - JOUR
T1 - Transient Ischemic Attacks Preceding Ischemic Stroke and the Possible Preconditioning of the Human Brain
T2 - A Systematic Review and Meta-Analysis
AU - Ghozy, Sherief
AU - Kacimi, Salah Eddine Oussama
AU - Elfil, Mohammed
AU - Sobeeh, Mohamed Gomaa
AU - Reda, Abdullah
AU - Kallmes, Kevin M.
AU - Rabinstein, Alejandro A.
AU - Holmes, David R.
AU - Brinjikji, Waleed
AU - Kadirvel, Ramanathan
AU - Kallmes, David F.
N1 - Publisher Copyright:
Copyright © 2021 Ghozy, Kacimi, Elfil, Sobeeh, Reda, Kallmes, Rabinstein, Holmes, Brinjikji, Kadirvel and Kallmes.
PY - 2021/11/24
Y1 - 2021/11/24
N2 - Stroke is a leading cause of mortality and disability worldwide. Transient ischemic attack (TIA) is defined as transient brain ischemia with temporary neurological deficits. In animal models, prior TIA seems to enhance brain ischemic tolerance to withstand further ischemic events, which might be explained by brain preconditioning. Thus, this review aims to formulate evidence of whether TIAs can induce positive preconditioning and enhance the functional outcomes in patients suffering from subsequent ischemic strokes. Five databases were searched (PubMed, Embase, SAGE, Web of Science, and Scopus), and twelve studies were included in the quantitative analysis. Studies were eligible when comparing patients with acute ischemic stroke (AIS) and previous TIA with those with AIS without TIA. Comparisons included the National Institute of Health Stroke Scale (NIHSS) score at admission and 7 days from the stroke event, modified Rankin score (mRS), and Trial of ORG 10,172 in Acute Stroke Treatment (TOAST) classification. Odds ratio (OR), mean difference (MD), and 95% confidence interval (CI) were used to describe our results using the random effect model. Our results revealed that patients with stroke and prior TIAs had lower NIHSS scores at admission than those without prior TIAs. However, the NIHSS score was not significantly different between the two groups at 7 days. Furthermore, there was no statistically significant difference between both groups in terms of mortality. Despite the differences in the admission mRS score groups, patients with prior TIAs had lower mRS scores at discharge.
AB - Stroke is a leading cause of mortality and disability worldwide. Transient ischemic attack (TIA) is defined as transient brain ischemia with temporary neurological deficits. In animal models, prior TIA seems to enhance brain ischemic tolerance to withstand further ischemic events, which might be explained by brain preconditioning. Thus, this review aims to formulate evidence of whether TIAs can induce positive preconditioning and enhance the functional outcomes in patients suffering from subsequent ischemic strokes. Five databases were searched (PubMed, Embase, SAGE, Web of Science, and Scopus), and twelve studies were included in the quantitative analysis. Studies were eligible when comparing patients with acute ischemic stroke (AIS) and previous TIA with those with AIS without TIA. Comparisons included the National Institute of Health Stroke Scale (NIHSS) score at admission and 7 days from the stroke event, modified Rankin score (mRS), and Trial of ORG 10,172 in Acute Stroke Treatment (TOAST) classification. Odds ratio (OR), mean difference (MD), and 95% confidence interval (CI) were used to describe our results using the random effect model. Our results revealed that patients with stroke and prior TIAs had lower NIHSS scores at admission than those without prior TIAs. However, the NIHSS score was not significantly different between the two groups at 7 days. Furthermore, there was no statistically significant difference between both groups in terms of mortality. Despite the differences in the admission mRS score groups, patients with prior TIAs had lower mRS scores at discharge.
KW - ischemic attack
KW - ischemic preconditioning
KW - meta-analysis
KW - neuroprotection
KW - stroke
KW - transient
UR - http://www.scopus.com/inward/record.url?scp=85120856076&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85120856076&partnerID=8YFLogxK
U2 - 10.3389/fneur.2021.755167
DO - 10.3389/fneur.2021.755167
M3 - Article
AN - SCOPUS:85120856076
SN - 1664-2295
VL - 12
JO - Frontiers in Neurology
JF - Frontiers in Neurology
M1 - 755167
ER -