Transient ischemic attacks and differentiated approaches to patient management for stroke prevention

Abstract. Introduction. According to WHO, stroke is the leading cause of disability in adults. The concept of cerebral circulatory disorders includes both stroke and transient cerebral circulatory disorders and transient ischemic attacks, and these are precursors to stroke. To assess the risk of its development, a clinical scale is used which includes items, such as age, blood pressure, clinical symptoms, duration of symptoms, and the presence of diabetes mellitus. The aim of this study is to develop a differentiated approach to secondary stroke prevention in patients with transient ischemic attacks. Material and Methods. This study involved 238 patients aged 31 to 86 years, treated for transient ischemic attacks in the clinic of the Centre for Emergency Medical Care within the period from 2011 to 2022. During our research, we used general clinical and special research methods, such as neurological examination, Glasco coma scale, National Institute of Health Stroke Scale, Modified Rankin scale, multispiral computed tomography, multispiral computed tomographic angiography, magnetic resonance tomography, and transcranial Doppler sonography. Results and Discussion. Five pathogenetic subtypes of transient ischemic attacks (atherothrombotic, cardioembolic, hemodynamic, lacunar, and hemorheological micro-occlusion) were revealed, the distribution of which depended on the treatment type: All subtypes in conservative therapy, only atherothrombotic and hemodynamic subtypes in classical carotid endarterectomy, and exclusively atherothrombotic subtype in stenting. Worsening of atherosclerotic lesion of carotid arteries was accompanied by a decrease in cognitive functions (Brief Mental Status Evaluation Scale: 25 to 22.5 points) and increase in neurological deficit (National Institutes of Health Stroke Scale: 7.1 to 8.6 points) and in the duration of transient ischemic attacks (144 to 344 min). Left ventricular hypertrophy and diabetes mellitus worsened the course of transient ischemic attacks, increasing cognitive and motor impairment, as well as the risk of stroke (clinical scale is used to assess the risk of early stroke after a transient ischemic attack: 4.7 and 5.1 points versus 3.8 and 4.3 points, p<0.01). Conclusions. Transient ischemic attacks, closely linked to ischemic stroke, progress based on the extent of carotid artery damage and risk factors like left ventricular hypertrophy and diabetes, which lead to worsening cognitive and neurological deficits and to increasing stroke risk in patients with advanced atherosclerosis and comorbidities.