Etiopathogenesis of transient ischemic attacks and minor ischemic strokes: a community-based study in Segovia, Spain.
OBJECTIVE
We sought to analyze the etiology and underlying vascular risk factors of transient ischemic attacks (TIAs) and minor ischemic strokes (MISs).


METHODS
We prospectively studied the vascular risk factors and etiologic categories in 235 patients with TIAs and MISs from a community-based register in a rural area of Spain. Five etiologic categories were considered: (1) cardioembolism, (2) large-artery atherosclerosis, (3) small-artery disease, (4) other etiologies, and (5) undetermined etiology. Systematic investigations included neuroimaging (CT/MRI) and vascular studies (duplex scan/MR angiography and angiography in selected cases).


RESULTS
The two most frequent etiologic categories were small-artery disease (31%) and cardioembolism (26%). Large-artery atherosclerosis was detected in 11% of the patients. Significant carotid stenosis (> or =50%) was present in 13% of patients with carotid territory events. No cause could be found or it was uncertain in almost one third of the patients. The distribution of etiologic categories was similar in TIAs and MISs. The most prevalent vascular risk factors were as follows: arterial hypertension (50%), smoking (26%), atrial fibrillation (20%), hypercholesterolemia (17%), diabetes (15%), ischemic heart disease (12%), and peripheral vascular disease (3%). Carotid bruits were detected in 3% of the patients.


CONCLUSIONS
An etiologic classification of TIAs and MISs is feasible. The two most frequent pathogenetic mechanisms in our study were small-artery disease and cardioembolism. The prevalence of large-artery atherosclerosis was low.
Sempere
A P
AP
Department of Neurology, Segovia General Hospital, Spain. aperezs@meditex.es
Duarte
J
J
Cabezas
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C
Clavería
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LE
D000368:Aged; D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000453:epidemiology; D001161:Arteriosclerosis / Q000150:complications / Q000453:epidemiology; D001281:Atrial Fibrillation / Q000150:complications / Q000453:epidemiology; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology*; D016893:Carotid Stenosis / Q000150:complications / Q000453:epidemiology; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000453:epidemiology; D004617:Embolism / Q000150:complications / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000453:epidemiology; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000453:epidemiology; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000209:etiology*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D017202:Myocardial Ischemia / Q000150:complications / Q000453:epidemiology; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D018608:Ultrasonography, Doppler; D014652:Vascular Diseases / Q000150:complications / Q000453:epidemiology