Background: We aimed to evaluate the epidemiological features of transient ischemic attack (TIA). Methods: All TIAs were prospectively collected in Dijon, France, using a population-based registry (2013–2015). TIAs were considered the first-ever in patients who had no previous cerebrovascular events (CVEs); otherwise they were considered recurrent TIAs. Annual incidence (first-ever TIAs) and attack rates (first-ever and recurrent TIAs) were calculated. Results: Four hundred twenty TIAs were registered (255 first-ever and 165 recurrent TIAs, mean age: 74.1 ± 15.7 years). The age-standardized incidence rate (to the 2013 European population) was 61 (95% CI 46–76) and the attack rate was 81 (95% CI 64–99) per 100,000/year. Patients with TIA as a recurrent event had a greater prevalence of risk factors and preventive treatments. However, one third of them were not receiving antithrombotic agents or antihypertensive treatments, and half were not treated with statins at the time of their recurrence. The mean ABCD2 score was 4.3 ± 1.3, and 72% of patients had a high risk of recurrence (score ≥4). In patients with available MRI (23%), an infarct lesion was seen in 15.5%. Conclusions: TIA is a frequent occurrence and a large proportion of patients have a high risk of recurrence, thus highlighting the need to establish dedicated emergency services to administer prompt secondary prevention.

Keywords:
Registry, Epidemiology, Transient ischemic attack, Incidence
1.
Sudlow CL, Warlow CP: Comparing stroke incidence worldwide: what makes studies comparable? Stroke 1996; 27: 550–558.
2.
Barber PA, Krishnamurthi R, Parag V, Anderson NE, Ranta A, Kilfoyle D, Wong E, Green G, Arroll B, Bennett DA, Witt E, Rush E, Minsun Suh F, Theadom A, Rathnasabapathy Y, Te Ao B, Parmar P, Feigin VL; ARCOS IV Study Group: Incidence of transient ischemic attack in Auckland, New Zealand, in 2011 to 2012. Stroke 2016; 47: 2183–2188.
3.
Fonseca PG, Weiss PA, Harger R, Moro CH, Longo AL, Gonçalves AR, Whiteley WN, Cabral NL: Transient ischemic attack incidence in joinville, Brazil, 2010: a population-based study. Stroke 2012; 43: 1159–1162.
4.
Díaz-Guzmán J, Egido JA, Gabriel-Sánchez R, Barberá-Comes G, Fuentes-Gimeno B, Fernández-Pérez C; IBERICTUS Study Investigators of the Stroke Project of the Spanish Cerebrovascular Diseases Study Group: Stroke and transient ischemic attack incidence rate in Spain: the IBERICTUS study. Cerebrovasc Dis 2012; 34: 272–281.
5.
Cancelli I, Janes F, Gigli GL, Perelli A, Zanchettin B, Canal G, D’Anna L, Russo V, Barbone F, Valente M: Incidence of transient ischemic attack and early stroke risk: validation of the ABCD2 score in an Italian population-based study. Stroke 2011; 42: 2751–2757.
6.
Von Weitzel-Mudersbach P, Andersen G, Hundborg HH, Johnsen SP: Transient ischemic attack and minor stroke are the most common manifestations of acute cerebrovascular disease: a prospective, population-based study – the Aarhus TIA study. Neuroepidemiology 2013; 40: 50–55.
7.
Béjot Y, Grelat M, Delpont B, Durier J, Rouaud O, Osseby GV, et al. Temporal trends in early case-fatality rates in patients with intracerebral hemorrhage. Neurology 2017; 88: 985–990.
8.
Giroud M, Delpont B, Daubail B, Blanc C, Durier J, Giroud M, Béjot Y: Temporal trends in sex differences with regard to stroke incidence: the Dijon Stroke Registry (1987–2012). Stroke 2017; 48: 846–849.
9.
Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V: Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol 2009; 8: 355–369.
10.
Bennett DA, Brayne C, Feigin VL, Barker-Collo S, Brainin M, Davis D, et al: Development of the standards of reporting of neurological disorders (STROND) checklist: a guideline for the reporting of incidence and prevalence studies in neuroepidemiology. Neurology 2015; 85: 821–828.
11.
WHO: The World Health Report 2000: Health Systems Improving Performance. -Geneva, World Health Organization, 2000.
12.
Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, Sidney S: Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet 2007; 369: 283–292.
13.
Ahmad O, Boschi-Pinto C, Lopez A, Murray C, Lozano R, Inoue M: Age Standardization of Rates: A New WHO Standard. GPE Discussion Paper Series: No. 31. Geneva, World Health Organization, 2000.
14.
Doll R, Cook P: Summarizing indices for comparison of cancer incidence data. Int J Cancer 1967; 2: 269–279.
15.
Office for National Statistics, UK. Revised -European Standard Population 2013. http://webarchive.nationalarchives.gov.uk/20160106020035/http://www.ons.gov.uk/ons/guide-method/user-guidance/health-and-life-events/revised-european-standard-population-2013-2013-esp-/index.html. The national archives (accessed September 4, 2017).
16.
Tavosian A, Ström JO, Appelros P: Incidence of transient ischemic attacks in Sweden. Neuroepidemiology 2016; 47: 20–25.
17.
Albers GW, Caplan LR, Easton JD, Fayad PB, Mohr JP, Saver JL, Sherman DG; TIA Working Group: Transient ischemic attack – proposal for a new definition. N Engl J Med 2002; 347: 1713–1716.
18.
Kelly PJ, Albers GW, Chatzikonstantinou A, De Marchis GM, Ferrari J, George P, Katan M, Knoflach M, Kim JS, Li L, Lee EJ, Olivot JM, Purroy F, Raposo N, Rothwell PM, Sharma VK, Song B, Tsivgoulis G, Walsh C, Xu Y, Merwick A: Validation and comparison of imaging-based scores for prediction of early stroke risk after transient ischaemic attack: a pooled analysis of individual-patient data from cohort studies. Lancet Neurol 2016; 15: 1238–1247.
19.
Shono K, Satomi J, Tada Y, Kanematsu Y, Yamamoto N, Izumi Y, Kaji R, Harada M, Nagahiro S: Optimal timing of diffusion-weighted imaging to avoid false-negative findings in patients with transient ischemic attack. Stroke 2017; 48: 1990–1992.
20.
Kidwell CS, Alger JR, Di Salle F, Starkman S, Villablanca P, Bentson J, Saver JL: Diffusion MRI in patients with transient ischemic attacks. Stroke 1999; 30: 1174–1180.
21.
Béjot Y, Zeller M, Lorgis L, Troisgros O, Aboa-Eboulé C, Osseby GV, Giroud M, Cottin Y: Secondary prevention in patients with vascular disease. A population based study on the underuse of recommended medications. J Neurol Neurosurg Psychiatry 2013; 84: 348–353.
22.
Asberg S, Henriksson KM, Farahmand B, et al: Ischemic stroke and secondary prevention in clinical practice: a cohort study of 14,529 patients in the Swedish stroke register. Stroke 2010; 41: 1338–1342.
23.
Glader EL, Sjölander M, Eriksson M, et al: Persistent use of secondary preventive drugs declines rapidly during the first 2 years after stroke. Stroke 2010; 41: 397–401.
24.
Bushnell CD, Olson DM, Zhao X, et al: Secondary preventive medication persistence and adherence 1 year after stroke. Neurology 2011; 77: 1182–1190.
25.
Amarenco P, Lavallée PC, Labreuche J, Albers GW, Bornstein NM, Canhão P, Caplan LR, Donnan GA, Ferro JM, Hennerici MG, Molina C, Rothwell PM, Sissani L, Školoudík D, Steg PG, Touboul PJ, Uchiyama S, Vicaut É, Wong LK; TIAregistry.org Investigators: One-year risk of stroke after transient ischemic attack or minor stroke. N Engl J Med 2016; 374: 1533–1542.
26.
Giles MF, Rothwell PM: Substantial underestimation of the need for outpatient services for TIA and minor stroke. Age Ageing 2007; 36: 676–680.
© 2017 S. Karger AG, Basel
2017
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.