TIA- Transient ischemic attack:
Abstract
ภาวะสมองขาดเลือดชั่วคราว (TIA) เป็นเหตุการณ์เตือนที่อาจพบนำมาก่อน ภาวะสมองตายเฉียบพลัน ซึ่งถือว่าเป็นภาวะฉุกเฉินทางระบบประสาท ผู้ป่วย TIA ที่มีความเสี่ยงสูง ควรจะได้รับการประเมินอย่างทันท่วงที เช่น ภายใน 24 ชั่วโมง การวินิจฉัยภาวะ True-TIA และแยกโรคอื่นๆ ที่อาจมีอาการคล้ายคลึงกันมีความสำคัญมาก ภาวะ TIA ที่อยู่ในช่วงระยะเฉียบพลัน จะมีความเสี่ยงสูง มากกว่ากรณีที่เป็นมาแล้วหลายสัปดาห์ การทำนายความเสี่ยงทางคลินิกเช่น การให้คะแนน ABCD2 ได้ถูกนำมาใช้ประกอบการพิจารณาดูแลรักษาผู้ป่วย การถ่ายภาพสมองด้วย MRI ที่เป็นทางเลือกที่ดี ในตรวจค้นเพิ่มเติม และประกอบการหาสาเหตุของภาวะ TIA ซึ่งมีสาเหตุที่เป็นได้มากมาย ผู้ป่วยที่มีสาเหตุจากหลอดเลือดแดงเลี้ยงสมองตีบ จะมีความเสี่ยงของการเกิดเป็นซ้ำค่อนข้างสูง การป้องกันการเป็นซ้ำ จากกรณีหลอดเลือดแดงตีบนั้น ยาต้านเกล็ดเลือดถือเป็นตัวเลือกที่ดีที่สุด แต่ในกรณีที่มีอาการจากหลอดเลือดแดงแคโรติดที่คอตีบรุนแรง การผ่าตัด carotid endarterectomy พบว่ามีประสิทธิภาพในการป้องกันสูงที่สุด ถ้าทำภายในสองสัปดาห์แรกหลังจาก TIA ส่วนกรณีที่เป็นสาเหตุจากหัวใจนั้น พบว่าภาวะหัวใจห้องบนเต้นพริ้ว (Arial fibrillation: AF) เป็นเหตุที่พบบ่อยที่สุด และผู้ป่วยจะได้ประโยชน์ จากการป้องกันการเป็นซ้ำด้วยยาป้องกันเลือดแข็งตัวอย่างมากนอกจากนี้ควรควบคุมปัจจัยเสี่ยงของโรคหลอดเลือดสมองโดยเฉพาะอย่างยิ่ง การควบคุมความดันโลหิตแก่ผู้ป่วยทุกราย
References
Rothwell PM, Warlow CP. Timing of TIAs preceding stroke: time window for prevention is very short. Neurology. 2005;64(5):817-20.
Albers GW, Caplan LR, Easton JD, Fayad PB, Mohr JP, Saver JL, et al. Transient ischemic attack-proposal for a new definition. N Engl J Med. 2002;347(21):1713-6.
Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Feldmann E, et al. Definition and evaluation of transient ischemic attack: a scientific
statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular
Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on
Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke.
2009;40(6):2276-93.
Hand PJ, Kwan J, Lindley RI, Dennis MS, Wardlaw JM. Distinguishing between stroke and mimic at the bedside: the brain attack study. Stroke. 2006;37(3):769-75.
Fallon C, Noone I, Ryan J, O’Shea D, O’Laoide R, Crowe M. Assessment and management of transient ischaemic attack--the role of the TIA clinic. Ir J Med
Sci. 2006;175(3):24-7.
Coull AJ, Rothwell PM. Underestimation of the early risk of recurrent stroke: evidence of the need for a standard definition. Stroke. 2004;35(8):1925-9.
Rothwell PM, Buchan A, Johnston SC. Recent advances in management of transient ischaemic attacks and minor ischaemic strokes. Lancet Neurol. 2006;5(4):323-31.
Coull AJ, Lovett JK, Rothwell PM, Study OV. Population based study of early risk of stroke after transient ischaemic attack or minor stroke: implications for public education and organisation of services. BMJ. 2004;328(7435):326.
Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, et al. Validation and refinement of scores to predict very early stroke
risk after transient ischaemic attack. Lancet. 2007;369(9558):283-92.
Chandratheva A, Mehta Z, Geraghty OC, Marquardt L, Rothwell PM, Study OV. Population-based study of risk and predictors of stroke in the first few hours
after a TIA. Neurology. 2009;72(22):1941-7.
Olivot JM, Wolford C, Castle J, Mlynash M, Schwartz NE, Lansberg MG, et al. Two aces: transient ischemic attack work-up as outpatient assessment of clinical
evaluation and safety. Stroke. 2011;42(7):1839-43.
Dai Q, Sun W, Xiong Y, Hankey GJ, Xiao L, Zhu W, et al. From clinical to tissue-based dual TIA: Validation and refinement of ABCD3-I score. Neurology. 2015;84(14):1426-32.
Ay H, Koroshetz WJ, Benner T, Vangel MG, Wu O, Schwamm LH, et al. Transient ischemic attack with infarction: a unique syndrome? Ann Neurol. 2005;57(5):679-86.
Giles MF, Albers GW, Amarenco P, Arsava EM, Asimos AW, Ay H, et al. Early stroke risk and ABCD2 score performance in tissue- vs time-defined TIA: a
multicenter study. Neurology. 2011;77(13):1222-8.
Sposato LA, Cipriano LE, Saposnik G, Ruíz Vargas E, Riccio PM, Hachinski V. Diagnosis of atrial fibrillation after stroke and transient ischaemic attack:
a systematic review and meta-analysis. Lancet Neurol. 2015;14(4):377-87.
Grotta JC. Clinical practice. Carotid stenosis. N Engl J Med. 2013;369(12):1143-50.
Dharmasaroja PA, Intharakham K. Risk factors for carotid stenosis in Thai patients with ischemic stroke/TIA. Angiology. 2010;61(8):789-92.
Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ, Collaboration CET. Endarterectomy for symptomatic carotid stenosis in relation to clinical
subgroups and timing of surgery. Lancet. 2004;363(9413):915-24.
Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N
Engl J Med. 2011;365(11):993-1003.
Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010;31(19):2369-429.
Lip GY, Frison L, Halperin JL, Lane DA. Identifying patients at high risk for stroke despite anticoagulation: a comparison of contemporary stroke risk stratification
schemes in an anticoagulated atrial fibrillation cohort. Stroke. 2010;41(12):2731-8.
Lane DA, Lip GY. Use of the CHA(2)DS(2)-VASc and HAS-BLED scores to aid decision making for thromboprophylaxis in nonvalvular atrial fibrillation.
Circulation. 2012;126(7):860-5.
Miller CS, Grandi SM, Shimony A, Filion KB, Eisenberg MJ. Meta-analysis of efficacy and safety of new oral anticoagulants (dabigatran, rivaroxaban,
apixaban) versus warfarin in patients with atrial fibrillation. Am J Cardiol. 2012;110(3):453-60.
Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet
therapy in various categories of patients. Antiplatelet Trialists’ Collaboration. BMJ. 1994;308(6921):81-106.
Halkes PH, van Gijn J, Kappelle LJ, Koudstaal PJ, Algra A, Group ES. Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial
origin (ESPRIT): randomised controlled trial. Lancet. 2006;367(9523):1665-73.
Sacco RL, Diener HC, Yusuf S, Cotton D, Ounpuu S, Lawton WA, et al. Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke.
N Engl J Med. 2008;359(12):1238-51.
Committee CS. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet. 1996;348(9038):1329-39.
Shinohara Y, Katayama Y, Uchiyama S, Yamaguchi T, Handa S, Matsuoka K, et al. Cilostazol for prevention of secondary stroke (CSPS 2): an aspirin-controlled, double-blind, randomised noninferiority trial. Lancet Neurol. 2010;9(10):959-68.
Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic
stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364(9431):331-7.
Benavente OR, Hart RG, McClure LA, Szychowski JM, Coffey CS, Pearce LA, et al. Effects of clopidogrel added to aspirin in patients with recent lacunar stroke.
N Engl J Med. 2012;367(9):817-25.
Rothwell PM, Giles MF, Chandratheva A, Marquardt L, Geraghty O, Redgrave JN, et al. Effect of urgent treatment of transient ischaemic attack and minor
stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet. 2007;370(9596):1432-42.
Markus HS, Droste DW, Kaps M, Larrue V, Lees KR, Siebler M, et al. Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial. Circulation. 2005;111(17):2233-40.
Wong KS, Chen C, Fu J, Chang HM, Suwanwela NC, Huang YN, et al. Clopidogrel plus aspirin versus aspirin alone for reducing embolisation in patients with
acute symptomatic cerebral or carotid artery stenosis (CLAIR study): a randomised, open-label, blindedendpoint trial. Lancet Neurol. 2010;9(5):489-97.
Kennedy J, Hill MD, Ryckborst KJ, Eliasziw M, Demchuk AM, Buchan AM, et al. Fast assessment of stroke and transient ischaemic attack to prevent early
recurrence (FASTER): a randomised controlled pilot trial. Lancet Neurol. 2007;6(11):961-9.
Wang Y, Zhao X, Liu L, Wang D, Wang C, Li H, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med. 2013;369(1):11-9.
Lee M, Saver JL, Hong KS, Rao NM, Wu YL, Ovbiagele B. Risk-benefit profile of long-term dualversus single-antiplatelet therapy among patients with ischemic stroke: a systematic review and metaanalysis. Ann Intern Med. 2013;159(7):463-70.
Boan AD, Lackland DT, Ovbiagele B. Lowering of blood pressure for recurrent stroke prevention. Stroke. 2014;45(8):2506-13.
Turnbull F, Collaboration BPLTT. Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectivelydesigned
overviews of randomised trials. Lancet. 2003;362(9395):1527-35.
Amarenco P, Bogousslavsky J, Callahan A, Goldstein LB, Hennerici M, Rudolph AE, et al. High-dose atorvastatin after stroke or transient ischemic attack.
N Engl J Med. 2006;355(6):549-59.
Jarcho JA, Keaney JF. Proof That Lower Is Better--LDL Cholesterol and IMPROVE-IT. N Engl J Med. 2015;372(25):2448-50.
Wang X, Dong Y, Qi X, Huang C, Hou L. Cholesterol levels and risk of hemorrhagic stroke: a systematic review and meta-analysis. Stroke. 2013;44(7):1833-9.
Albers GW, Caplan LR, Easton JD, Fayad PB, Mohr JP, Saver JL, et al. Transient ischemic attack-proposal for a new definition. N Engl J Med. 2002;347(21):1713-6.
Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Feldmann E, et al. Definition and evaluation of transient ischemic attack: a scientific
statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular
Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on
Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke.
2009;40(6):2276-93.
Hand PJ, Kwan J, Lindley RI, Dennis MS, Wardlaw JM. Distinguishing between stroke and mimic at the bedside: the brain attack study. Stroke. 2006;37(3):769-75.
Fallon C, Noone I, Ryan J, O’Shea D, O’Laoide R, Crowe M. Assessment and management of transient ischaemic attack--the role of the TIA clinic. Ir J Med
Sci. 2006;175(3):24-7.
Coull AJ, Rothwell PM. Underestimation of the early risk of recurrent stroke: evidence of the need for a standard definition. Stroke. 2004;35(8):1925-9.
Rothwell PM, Buchan A, Johnston SC. Recent advances in management of transient ischaemic attacks and minor ischaemic strokes. Lancet Neurol. 2006;5(4):323-31.
Coull AJ, Lovett JK, Rothwell PM, Study OV. Population based study of early risk of stroke after transient ischaemic attack or minor stroke: implications for public education and organisation of services. BMJ. 2004;328(7435):326.
Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, et al. Validation and refinement of scores to predict very early stroke
risk after transient ischaemic attack. Lancet. 2007;369(9558):283-92.
Chandratheva A, Mehta Z, Geraghty OC, Marquardt L, Rothwell PM, Study OV. Population-based study of risk and predictors of stroke in the first few hours
after a TIA. Neurology. 2009;72(22):1941-7.
Olivot JM, Wolford C, Castle J, Mlynash M, Schwartz NE, Lansberg MG, et al. Two aces: transient ischemic attack work-up as outpatient assessment of clinical
evaluation and safety. Stroke. 2011;42(7):1839-43.
Dai Q, Sun W, Xiong Y, Hankey GJ, Xiao L, Zhu W, et al. From clinical to tissue-based dual TIA: Validation and refinement of ABCD3-I score. Neurology. 2015;84(14):1426-32.
Ay H, Koroshetz WJ, Benner T, Vangel MG, Wu O, Schwamm LH, et al. Transient ischemic attack with infarction: a unique syndrome? Ann Neurol. 2005;57(5):679-86.
Giles MF, Albers GW, Amarenco P, Arsava EM, Asimos AW, Ay H, et al. Early stroke risk and ABCD2 score performance in tissue- vs time-defined TIA: a
multicenter study. Neurology. 2011;77(13):1222-8.
Sposato LA, Cipriano LE, Saposnik G, Ruíz Vargas E, Riccio PM, Hachinski V. Diagnosis of atrial fibrillation after stroke and transient ischaemic attack:
a systematic review and meta-analysis. Lancet Neurol. 2015;14(4):377-87.
Grotta JC. Clinical practice. Carotid stenosis. N Engl J Med. 2013;369(12):1143-50.
Dharmasaroja PA, Intharakham K. Risk factors for carotid stenosis in Thai patients with ischemic stroke/TIA. Angiology. 2010;61(8):789-92.
Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ, Collaboration CET. Endarterectomy for symptomatic carotid stenosis in relation to clinical
subgroups and timing of surgery. Lancet. 2004;363(9413):915-24.
Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N
Engl J Med. 2011;365(11):993-1003.
Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010;31(19):2369-429.
Lip GY, Frison L, Halperin JL, Lane DA. Identifying patients at high risk for stroke despite anticoagulation: a comparison of contemporary stroke risk stratification
schemes in an anticoagulated atrial fibrillation cohort. Stroke. 2010;41(12):2731-8.
Lane DA, Lip GY. Use of the CHA(2)DS(2)-VASc and HAS-BLED scores to aid decision making for thromboprophylaxis in nonvalvular atrial fibrillation.
Circulation. 2012;126(7):860-5.
Miller CS, Grandi SM, Shimony A, Filion KB, Eisenberg MJ. Meta-analysis of efficacy and safety of new oral anticoagulants (dabigatran, rivaroxaban,
apixaban) versus warfarin in patients with atrial fibrillation. Am J Cardiol. 2012;110(3):453-60.
Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet
therapy in various categories of patients. Antiplatelet Trialists’ Collaboration. BMJ. 1994;308(6921):81-106.
Halkes PH, van Gijn J, Kappelle LJ, Koudstaal PJ, Algra A, Group ES. Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial
origin (ESPRIT): randomised controlled trial. Lancet. 2006;367(9523):1665-73.
Sacco RL, Diener HC, Yusuf S, Cotton D, Ounpuu S, Lawton WA, et al. Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke.
N Engl J Med. 2008;359(12):1238-51.
Committee CS. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet. 1996;348(9038):1329-39.
Shinohara Y, Katayama Y, Uchiyama S, Yamaguchi T, Handa S, Matsuoka K, et al. Cilostazol for prevention of secondary stroke (CSPS 2): an aspirin-controlled, double-blind, randomised noninferiority trial. Lancet Neurol. 2010;9(10):959-68.
Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic
stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364(9431):331-7.
Benavente OR, Hart RG, McClure LA, Szychowski JM, Coffey CS, Pearce LA, et al. Effects of clopidogrel added to aspirin in patients with recent lacunar stroke.
N Engl J Med. 2012;367(9):817-25.
Rothwell PM, Giles MF, Chandratheva A, Marquardt L, Geraghty O, Redgrave JN, et al. Effect of urgent treatment of transient ischaemic attack and minor
stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet. 2007;370(9596):1432-42.
Markus HS, Droste DW, Kaps M, Larrue V, Lees KR, Siebler M, et al. Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial. Circulation. 2005;111(17):2233-40.
Wong KS, Chen C, Fu J, Chang HM, Suwanwela NC, Huang YN, et al. Clopidogrel plus aspirin versus aspirin alone for reducing embolisation in patients with
acute symptomatic cerebral or carotid artery stenosis (CLAIR study): a randomised, open-label, blindedendpoint trial. Lancet Neurol. 2010;9(5):489-97.
Kennedy J, Hill MD, Ryckborst KJ, Eliasziw M, Demchuk AM, Buchan AM, et al. Fast assessment of stroke and transient ischaemic attack to prevent early
recurrence (FASTER): a randomised controlled pilot trial. Lancet Neurol. 2007;6(11):961-9.
Wang Y, Zhao X, Liu L, Wang D, Wang C, Li H, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med. 2013;369(1):11-9.
Lee M, Saver JL, Hong KS, Rao NM, Wu YL, Ovbiagele B. Risk-benefit profile of long-term dualversus single-antiplatelet therapy among patients with ischemic stroke: a systematic review and metaanalysis. Ann Intern Med. 2013;159(7):463-70.
Boan AD, Lackland DT, Ovbiagele B. Lowering of blood pressure for recurrent stroke prevention. Stroke. 2014;45(8):2506-13.
Turnbull F, Collaboration BPLTT. Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectivelydesigned
overviews of randomised trials. Lancet. 2003;362(9395):1527-35.
Amarenco P, Bogousslavsky J, Callahan A, Goldstein LB, Hennerici M, Rudolph AE, et al. High-dose atorvastatin after stroke or transient ischemic attack.
N Engl J Med. 2006;355(6):549-59.
Jarcho JA, Keaney JF. Proof That Lower Is Better--LDL Cholesterol and IMPROVE-IT. N Engl J Med. 2015;372(25):2448-50.
Wang X, Dong Y, Qi X, Huang C, Hou L. Cholesterol levels and risk of hemorrhagic stroke: a systematic review and meta-analysis. Stroke. 2013;44(7):1833-9.
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เจียรนัยศิลป์ ศ. TIA- Transient ischemic attack:. J Thai Stroke Soc [Internet]. 2019 Feb. 14 [cited 2024 Jul. 27];14(3):153-65. Available from: https://he01.tci-thaijo.org/index.php/jtss/article/view/172423
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ข้อความภายในบทความที่ตีพิมพ์ในวารสารสมาคมโรคหลอดเลือดสมองไทยเล่มนี้ ตลอดจนความรับผิดชอบด้านเนื้อหาและการตรวจร่างบทความเป็นของผู้นิพนธ์ ไม่เกี่ยวข้องกับกองบรรณาธิการแต่อย่างใด การนำเนื้อหา ข้อความหรือข้อคิดเห็นของบทความไปเผยแพร่ ต้องได้รับอนุญาตจากกองบรรณาธิการอย่างเป็นลายลักษณ์อักษร ผลงานที่ได้รับการตีพิมพ์ในวารสารเล่มนี้ถือเป็นลิขสิทธิ์ของวารสาร
