Optimizing the definitions of stroke, transient ischemic attack, and infarction for research and application in clinical practice

Abbott, Anne L., Silvestrini, Mauro, Topakian, Raffi, Golledge, Jonathan, Brunser, Alejandro M., de Borst, Gert J., Harbaugh, Robert E., Doubal, Fergus N., Rundek, Tatjana, Thapar, Ankur, Davies, Alun H., Kam, Anthony, and Wardlaw, Joanna M. (2017) Optimizing the definitions of stroke, transient ischemic attack, and infarction for research and application in clinical practice. Frontiers in Neurology, 8. 537.

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Background and purpose: Until now, stroke and transient ischemic attack (TIA) have been clinically based terms which describe the presence and duration of characteristic neurological deficits attributable to intrinsic disorders of particular arteries supplying the brain, retina, or (sometimes) the spinal cord. Further, infarction has been pathologically defined as death of neural tissue due to reduced blood supply. Recently, it has been proposed we shift to definitions of stroke and TIA determined by neuroimaging results alone and that neuroimaging findings be equated with infarction.

Methods: We examined the scientific validity and clinical implications of these proposals using the existing published literature and our own experience in research and clinical practice.

Results: We found that the proposals to change to imaging-dominant definitions, as published, are ambiguous and inconsistent. Therefore, they cannot provide the standardization required in research or its application in clinical practice. Further, we found that the proposals are scientifically incorrect because neuroimaging findings do not always correlate with the clinical status or the presence of infarction. In addition, we found that attempts to use the proposals are disrupting research, are otherwise clinically unhelpful and do not solve the problems they were proposed to solve.

Conclusion: We advise that the proposals must not be accepted. In particular, we explain why the clinical focus of the definitions of stroke and TIA should be retained with continued sub-classification of these syndromes depending neuroimaging results (with or without other information) and that infarction should remain a pathological term. We outline ways the established clinically based definitions of stroke and TIA, and use of them, may be improved to encourage better patient outcomes in the modern era.

Item ID: 51603
Item Type: Article (Research - C1)
ISSN: 1664-2295
Keywords: stroke, transient ischaemic attack, infarction, asymptomatic carotid stenosis, public health practice
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© 2017 Abbott, Silvestrini, Topakian, Golledge, Brunser, de Borst, Harbaugh, Doubal, Rundek, Thapar, Davies, Kam and Wardlaw. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Date Deposited: 22 Nov 2017 07:33
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3201 Cardiovascular medicine and haematology > 320199 Cardiovascular medicine and haematology not elsewhere classified @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920103 Cardiovascular System and Diseases @ 100%
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