Potential neuroprotective effects of transient ischaemic attacks in acute ischaemic stroke

Aims: There has recently emerged rather convincing evidence that brief ischemic events, clinically manifested as transient ischemic attacks (TIAs), may bring about ischemic tolerance, i.e. have a protective effect on the development of more severe ischemic brain lesion that often follows TIAs.

Objective: The paper aims to evaluate the clinical correlates that may show the presence of ischemic preconditioning in the development of ischemic stroke preceded by one or more TIAs.

Methods and subjects: 218 retrospective patients treated for acute ischemic stroke in the previous five years were classified into 4 relatively homogeneous groups. First all patients were divided into two groups; with lacunar and with non-lacunar infarcts, and then patients who suffered ipsilateral TIAs within the previous 72 hours were subdivided from each of the groups. Patients were evaluated and treated according to the latest European Stroke Initiative (EUSI) guidelines. In addition to all relevant clinical variables, special attention was paid to the disease outcome in the subacute phase, i.e. at discharge from hospital. A good outcome was formulated as the score of 0–2 on the modified Rankin Scale (mRS). Neurological status was followed using the Scandinavian Stroke Scale (SSS).

Results: There was no significant difference between the two groups of patients with lacunar infarcts (with and without TIAs); both groups had overall a good treatment outcome. As regards the two groups with non-lacunar infarcts, there was a significantly higher percentage of patients with a favorable treatment outcome in the group with previous TIAs (71%) compared to the group with no previous TIAs (40%), p<0.03.

Conclusion: The results suggested that preceding TIAs may have had neuroprotective effects in the group of patients with non-lacunar infarcts