medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-10-22-33medsovet-6256Research ArticleЦЕРЕБРОВАСКУЛЯРНЫЕ ЗАБОЛЕВАНИЯCEREBROVASCULAR DISEASESАктуальные аспекты медицинской реабилитации пациентов, перенесших транзиторную ишемическую атакуPriorities of medical rehabilitation of patients with recent experience of transient ischemic attackhttps://orcid.org/0000-0003-0629-9659КостенкоЕ. В.KostenkoE. V.

Костенко Елена Владимировна - доктор медицинских наук, профессор кафедры неврологии, нейрохирургии и медицинской генетики, РНИМУ им. Н.И. Пирогова; главный научный сотрудник, МНПЦМРВСМ.

117997, Москва, ул. Островитянова, д. 1;м105005, Москва, ул. Бауманская, д. 70

Elena V. Kostenko - Dr. Sci. (Med.), Professor of the Department of Neurology, Neurosurgery and Medical Genetics, Pirogov RNRMU; Chief Researcher, MCR&PMR, RSM.

1, Ostrovityanov St., Moscow, 117997; 70, Baumanskaya St., Moscow, 105005

Ekostenko58@mail.ruhttps://orcid.org/0000-0003-0353-553XПетроваЛ. В.PetrovaL. V.

Петрова Людмила Владимировна, кандидат медицинских наук, заведующая неврологическим отделением, старший научный сотрудник отдела медицинской реабилитации.

105005, Москва, ул. Бауманская, д. 70

Liudmila V. Petrova, Cand. Sci. (Med.), Head of the Department of Neurology, Senior Researcher of the Department of Medical Rehabilitation.

70, Baumanskaya St., Moscow, 105005

ludmila.v.petrova@yandex.ruhttps://orcid.org/0000-0002-3747-2111ЭнееваМ. А.EneevaM. A.

Энеева Малика Ахматовна - кандидат медицинских наук, заведующая неврологическим отделением.

105005, Москва, ул. Бауманская, д. 70

Malika A. Eneeva, Cand. Sci. (Med.), Head of the Neurological Department.

70, Baumanskaya St., Moscow, 105005

eneeva.m@yandex.ruhttps://orcid.org/0000-0002-1118-8462КравченкоВ. Г.KravchenkoV. G.

Виктория Германовна Кравченко - ассистент кафедры общественного здоровья и здравоохранения, экономики здравоохранения.

117997, Москва, ул. Островитянова, д. 1

Viktoriya G. Kravchenko, Assistant at the Department of Public Health and Health Care, Health Economics.

1, Ostrovityanov St., Moscow, 117997

krauchetz@rambler.ruРоссийский национальный исследовательский медицинский университет им. Н.И. Пирогова; Московский научно-практический центр медицинской реабилитации, восстановительной и спортивной медициныРоссияPirogov Russian National Research Medical University; Moscow Centre for Research & Practice in Medical Rehabilitation, Restorative and Sports MedicineRussian FederationМосковский научно-практический центр медицинской реабилитации, восстановительной и спортивной медициныРоссияMoscow Centre for Research & Practice in Medical Rehabilitation, Restorative and Sports MedicineRussian FederationРоссийский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation2021070820210102233Copyright © Костенко Е.В., Петрова Л.В., Энеева М.А., Кравченко В.Г., 20212021Костенко Е.В., Петрова Л.В., Энеева М.А., Кравченко В.Г.Kostenko E.V., Petrova L.V., Eneeva M.A., Kravchenko V.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6256Введение

Введение. Транзиторные ишемические атаки (ТИА) могут являться предвестником тяжелого сердечно-сосудистого события, многофакторность риска развития которого требует персонифицированного подхода. Нейропсихологические нарушения (когнитивные, эмоциональные) существенно влияют на качество жизни и социальную активность пациентов с ТИА. Комплексная медицинская реабилитация с включением антитромботической терапии и психокоррекционных мероприятий может снижать риск повторных кардиоваскулярных событий.

Цель исследования

Цель исследования: научно обосновать эффективность комплексных медикаментозных и нефармакологических реабилитационных мероприятий у пациентов, перенесших ТИА, с учетом особенностей основного и сопутствующих заболеваний. Материалы и методы. Была изучена заболеваемость у 351 пациента, перенесшего ТИА: средний возраст 58,6 ± 2,2 года, женщин - 64,9%, мужчин - 35,1%. Все пациенты в течение 12 мес. получали индивидуализированную программу медицинской реабилитации с обязательной коррекцией выявленных нейропсихологических расстройств. В зависимости от фоновых и сопутствующих заболеваний осуществлялось дифференцированное назначение антитромботической терапии.

Результаты и обсуждение

Результаты и обсуждение. Выявлен разнообразный спектр остаточных проблем после ТИА, включая психологические, когнитивные и физические нарушения (по субъективным жалобам). Распространенность психических расстройств у пациентов с ТИА составила 138,2 случая на 100 пациентов. Проведенная коррекция психических расстройств позволила значимо (р < 0,05) улучшить показатели когнитивного, эмоционального статусов и качества жизни. Повторное острое цереброваскулярное событие (ТИА, ишемический инсульт) было зарегистрировано в течение первых 6 мес. после ТИА у 29 пациентов (10,4%) с наличием выраженных стенозов брахиоцефальных артерий, тяжелой артериальной гипертензией, пароксизмальной формой фибрилляции предсердий.

Заключение

Заключение. Определена необходимость проведения комплексной медико-социальной реабилитации пациентов, перенесших ТИА, с участием психотерапевта в составе мультидисциплинарной команды. Подчеркнута важность рациональной антитромботической терапии во вторичной профилактике острого цереброваскулярного события.

Introduction

Introduction. Transient ischemic attacks can be a predictor of a more severe cardiovascular event, the risk of which depends on many factors that requires a personalized approach. Neuropsychological disorders (cognitive, emotional) have a significant impact on quality of life and social activity and are often underestimated in patients with TIA. Comprehensive medical rehabilitation with the inclusion of antithrombotic therapy and psychocorrection measures may reduce the risk of recurrent cardiovascular events in patients with TIA.

Purpose of the study

Purpose of the study: to substantiate the efficiency of complex medical and non-pharmacological rehabilitation in patients who underwent TIA by analyzing the characteristics of the main and leading concomitant diseases.

Materials and methods

Materials and methods. The morbidity of 351 TIA patients was studied and analyzed. The average age of the examined patients was 58.6 ± 2.2 years, there were 64.9% of women and 35.1% of men. All patients received an individualized medical rehabilitation program for 12 months with correction of identified neuropsychological disorders. Depending on background and concomitant diseases the antiplatelet or anticoagulants therapy was differently administrated.

Results and dicussion

Results and dicussion. Psychological, cognitive, and physical disorders (based on subjective complaints) are common in patients with TIA. The prevalence of mental disorders in patients with TIA was 138.2 cases per 100 patients. The correction of cognitive impairment, depressive symptoms is associated with improved quality of life (p < 0.05). Repeated acute cerebrovascular events (TIA, ischemic stroke) were recorded during the first 6 months after TIA in 29 patients (10.4%) with severe stenosis of the brachiocephalic arteries, severe arterial hypertension and paroxysmal atrial fibrillation.

Conclusion

Conclusion. The importance of comprehensive medical and social rehabilitation of patients with TIA is determined. The participation of a psychotherapist as a member of a multidisciplinary team is necessary. A significant role of the secondary prevention of acute cerebrovascular events is assigned to rational antithrombotic therapy.

транзиторные ишемические атакикогнитивные нарушенияэмоциональные расстройствамедицинская реабилитациявторичная профилактика инсультаантиагрегантыдипиридамолTIAcognitive disordersemotional disordersmedical rehabilitationsecondary prevention of strokeantiplatelet therapydipyridamoleReferencesУчияма Ш., Амаренко П., Минемацу К., Вонг К.СЛ. Транзиторные ишемические атаки. М.: ГЕОТАР-Медиа; 2016. 224 с. Режим доступа: https://fUeskachat.com/download/71450_8a8321f86e35e87ee973a78f0913a04f.html.Uchiyama S., Amarenco P., Minematsu K., Wong K.S.L. (eds.). TIA as Acute Cerebrovascular Syndrome. Frontiers of Neurology and Neuroscience. Basel, Karger; 2014. Vol. 33. https://doi.org/10.1159/isbn.978-3-318-02459-3.Simmons B.B., Cirignano B., Gadegbeku A.B. Transient ischemic attack: Part I. Diagnosis and evaluation. Am Fam Physician. 2012;86(6):521-526. Available at: https://pubmed.ncbi.nlm.nih.gov/23062043/Simmons B.B., Cirignano B., Gadegbeku A.B. Transient ischemic attack: Part I. Diagnosis and evaluation. Am Fam Physician. 2012;86(6):521-526. Available at: https://pubmed.ncbi.nlm.nih.gov/23062043/Johnston S.C. Clinical practice. Transient ischemic attack. N Engl J Med. 2002;347(21):1687-1692. https://doi.org/10.1056/NEJMcp020891.Johnston S.C. Clinical practice. Transient ischemic attack. N Engl J Med. 2002;347(21):1687-1692. https://doi.org/10.1056/NEJMcp020891.Gupta H., Farrell A., Mittal M. Transient ischemic attacks: predictability of future ischemic stroke or transient ischemic attack events. Ther Clin Risk Manag. 2014;10:27-35. https://doi.org/10.2147ACRM.S54810.Gupta H., Farrell A., Mittal M. Transient ischemic attacks: predictability of future ischemic stroke or transient ischemic attack events. Ther Clin Risk Manag. 2014;10:27-35. https://doi.org/10.2147ACRM.S54810.Johnston S.C., Rothwell P.M., Nguyen-Huynh M.N., Giles M.F., Elkins J.S., Bernstein A.L., Sidney S. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007;369(9558): 283-292. https://doi.org/10.1016/S0140-6736(07)60150-0.Johnston S.C., Rothwell P.M., Nguyen-Huynh M.N., Giles M.F., Elkins J.S., Bernstein A.L., Sidney S. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007;369(9558): 283-292. https://doi.org/10.1016/S0140-6736(07)60150-0.Rothwell PM., Giles M.F., Chandratheva A., Marquardt L., Geraghty O., Redgrave J.N., Lovelock C.E. 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):1432-1442. https://doi.org/10.1016/S0140-6736(07)61448-2.Rothwell PM., Giles M.F., Chandratheva A., Marquardt L., Geraghty O., Redgrave J.N., Lovelock C.E. 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):1432-1442. https://doi.org/10.1016/S0140-6736(07)61448-2.Heron N., Kee F., Mant J., Cupples M.E., Donnelly M. Rehabilitation of patients after transient ischaemic attack or minor stroke: pilot feasibility randomised trial of a home-based prevention programme. Br J Gen Pract. 2019;69(687):e706-e714. https://doi.org/0.3399/bjgp19X705509.Heron N., Kee F., Mant J., Cupples M.E., Donnelly M. Rehabilitation of patients after transient ischaemic attack or minor stroke: pilot feasibility randomised trial of a home-based prevention programme. Br J Gen Pract. 2019;69(687):e706-e714. https://doi.org/0.3399/bjgp19X705509.Костенко Е.В., Петрова Л.В. Транзиторные ишемические атаки: их значимость в прогрессировании цереброваскулярных заболеваний и актуальные вопросы медицинской реабилитации. Медицинский ^вет. 2019;(9):22-30. 10.21518/2079-701X-2019-9-22-30.Kostenko E.V., Petrova L.V. Transient ischemic attacks: significance in the progression of cerebrovascular diseases and current issues of medical rehabilitation. Meditsinskiysovet = Medical Council. 2019;(9):22-30. (In Russ.) https://doi.org/10.21518/2079-701X-2019-9-22-30.Turner G.M., McMullan C., Atkins L., Foy R., Mant J., Calvert M. TIA and minor stroke: a qualitative study of long-term impact and experiences of follow-up care. BMC Fam Pract. 2019;20(1):176. https://doi.org/10.1186/s12875-019-1057-x.Turner G.M., McMullan C., Atkins L., Foy R., Mant J., Calvert M. TIA and minor stroke: a qualitative study of long-term impact and experiences of follow-up care. BMC Fam Pract. 2019;20(1):176. https://doi.org/10.1186/s12875-019-1057-x.Moran G.M., Fletcher B., Feltham M.G., Calvert M., Sackley C., Marshall T. Fatigue, psychological and cognitive impairment following transient ischaemic attack and minor stroke: a systematic review. Eur J Neurol. 2014;21(10):1258-1267. https://doi.org/10.1111/ene.12469.Moran G.M., Fletcher B., Feltham M.G., Calvert M., Sackley C., Marshall T. Fatigue, psychological and cognitive impairment following transientSackley C.M., Mant J., McManus RJ. Functional and emotional outcomes after transient ischemic attack: a 12-month prospective controlled cohort study. Int J Stroke. 2019;14(5):522-529. https://doi.org/10.1177/1747493018823158.Sackley C.M., Mant J., McManus RJ. Functional and emotional outcomes after transient ischemic attack: a 12-month prospective controlled cohort study. Int J Stroke. 2019;14(5):522-529. https://doi.org/10.1177/1747493018823158.Turner G.M., Calvert M., Feltham M.G., Ryan R., Marshall T. Ongoing impairments following transient ischaemic attack: retrospective cohort study. Eur J Neurol. 2016;23(11):1642-1650. https://doi.org/10.1111/ene.13088.Turner G.M., Calvert M., Feltham M.G., Ryan R., Marshall T. Ongoing impairments following transient ischaemic attack: retrospective cohort study. Eur J Neurol. 2016;23(11):1642-1650. https://doi.org/10.1111/ene.13088.van Rooij F.G.. Plaizier N.O., Vermeer S.E., Goraj B.M., Koudstaal PJ., Richard E. et al. Subjective Cognitive Impairment, Depressive Symptoms, and Fatigue after a TIA or Transient Neurological Attack: A Prospective Study. Behav Neurol. 2017;2017:5181024. https://doi.org/10.1155/2017/5181024.van Rooij F.G., Plaizier N.O., Vermeer S.E., Goraj B.M., Koudstaal PJ., Richard E. et al. Subjective Cognitive Impairment, Depressive Symptoms, and Fatigue after a TIA or Transient Neurological Attack: A Prospective Study. Behav Neurol. 2017;2017:5181024. https://doi.org/10.1155/2017/5181024.Muus I., Petzold M., Ringsberg K.C. Health-related quality of life among Danish patients 3 and 12 months after TIA or mild stroke. Scand J Caring Sci. 2010;24(2):211-218. https://doi.org/10.1111/j.1471-6712.2009.00705.x.Muus I., Petzold M., Ringsberg K.C. Health-related quality of life among Danish patients 3 and 12 months after TIA or mild stroke. ScandJ Caring Sci. 2010;24(2):211-218. https://doi.org/10.1111/j.1471-6712.2009.00705.x.Verbraak M.E., Hoeksma A.F., Lindeboom R., Kwa V.I. Subtle problems in activities of daily living after a transient ischemic attack or an apparently fully recovered non-disabling stroke. J Stroke Cerebrovasc Dis. 2012;21(2):124-130. https://doi.org/10.1016/j.jstrokecerebrovasdis.2010.05.012.Verbraak M.E., Hoeksma A.F., Lindeboom R., Kwa V.I. Subtle problems in activities of daily living after a transient ischemic attack or an apparently fully recovered non-disabling stroke. J Stroke Cerebrovasc Dis. 2012;21(2):124-130. https://doi.org/10.1016/j.jstrokecerebrovasdis.2010.05.012.Wang Y.L., Pan Y.S., Zhao X.O., Wang D., Johnston S.C., Liu L.P. et al. Recurrent stroke was associated with poor quality of life in patients with transient ischemic attack or minor stroke: finding from the CHANCE trial. CNS Neurosci Ther. 2014;20(12):1029-1035. https://doi.org/10.1111/cns.12329.Wang Y.L., Pan Y.S., Zhao X.O., Wang D., Johnston S.C., Liu L.P. et al. Recurrent stroke was associated with poor quality of life in patients with transient ischemic attack or minor stroke: finding from the CHANCE trial. CNS Neurosci Ther. 2014;20(12):1029-1035. https://doi.org/10.1111/cns.12329.Carlsson G.E., Moller A., Blomstrand C. Managing an everyday life of uncertainty - a qualitative study of coping in persons with mild stroke. Disabil Rehabil. 2009;31(10):773-782. https://doi.org/10.1080/09638280802638857.Carlsson G.E., Moller A., Blomstrand C. Managing an everyday life of uncertainty - a qualitative study of coping in persons with mild stroke. Disabil Rehabil. 2009;31(10):773-782. https://doi.org/10.1080/09638280802638857.Edwards D.F., Hahn M., Baum C., Dromerick A.W. The impact of mild stroke on meaningful activity and life satisfaction. J Stroke Cerebrovasc Dis. 2006;15(4): 151-157. https://doi.org/10.1016/j.jstrokecerebrovasdis.2006.04.001.Edwards D.F., Hahn M., Baum C., Dromerick A.W. The impact of mild stroke on meaningful activity and life satisfaction. J Stroke Cerebrovasc Dis. 200615(4)151-157. https://doi.org/10.1016/].jstrokecerebrovasdis.2006.04.001.Fride Y, Adamit T., Maeir A., Ben Assayag E., Bornstein N.M., Korczyn A.D., Katz N. What are the correlates of cognition and participation to return to work after first ever mild stroke? Top Stroke Rehabil. 2015;22(5):317-325. https://doi.org/10.1179/1074935714Z.0000000013.Fride Y., Adamit T., Maeir A., Ben Assayag E., Bornstein N.M., Korczyn A.D., Katz N. What are the correlates of cognition and participation to return to work after first ever mild stroke? Top Stroke Rehabil. 2015;22(5):317-325. https://doi.org/10.1179/1074935714Z.0000000013.Hommel M., Trabucco-Miguel S., Joray S., Naegele B., Gonnet N., Jaillard A. Social dysfunctioning after mild to moderate first-ever stroke at vocational age. J Neurol Neurosurg Psychiatry. 2009;80(4):371-375. https://doi.org/10.1136/jnnp.2008.157875.Hommel M., Trabucco-Miguel S., Joray S., Naegele B., Gonnet N., Jaillard A. Social dysfunctioning after mild to moderate first-ever stroke at vocational age. J Neurol Neurosurg Psychiatry. 2009;80(4):371-375. https://doi.org/10.1136/jnnp.2008.157875.Crowfoot G., van der Riet P., Maguire J. Real-Life experiences of people with transient ischaemic attack or minor stroke: A qualitative literature review. J Clin Nurs. 2018;27(7-8):1381-1398. https://doi.org/10.1111/jocn.14271.Crowfoot G., van der Riet P., Maguire J. Real-life experiences of people with transient ischaemic attack or minor stroke: A qualitative literature review. J Clin Nurs. 2018;27(7-8):1381-1398. https://doi.org/10.1111/jocn.14271.Chun H.Y., Whiteley W.N., Dennis M.S., Mead G.E., Carson AJ. Anxiety After Stroke: The Importance of Subtyping. Stroke. 2018;49(3):556-564. https://doi.org/10.1161/STROKEAHA.117.020078.Chun H.Y., Whiteley W.N., Dennis M.S., Mead G.E., Carson AJ. Anxiety After Stroke: The Importance of Subtyping. Stroke. 2018;49(3):556-564. https://doi.org/10.1161/STROKEAHA.117.020078.Kirkpatrick S., Locock L., Giles M.F., Lasserson D.S. Non-focal neurological symptoms associated with classical presentations of transient ischaemic attack: qualitative analysis of interviews with patients. PLoS One. 2013;8(6):e66351. https://doi.org/10.1371/journal.pone.0066351.Kirkpatrick S., Locock L., Giles M.F., Lasserson D.S. Non-focal neurological symptoms associated with classical presentations of transient ischaemic attack: qualitative analysis of interviews with patients. PLoS One. 2013;8(6):e66351. https://doi.org/10.1371/journal.pone.0066351.Carnes-Vendrell A., Deus J., Molina-Seguin J., Pifarre J., Purroy F. Depression and Apathy After Transient Ischemic Attack or Minor Stroke: Prevalence, Evolution and Predictors. Sci Rep. 2019;9(1):16248. https://doi.org/10.1038/s41598-019-52721-5.Carnes-Vendrell A., Deus J., Molina-Seguin J., Pifarre J., Purroy F. Depression and Apathy After Transient Ischemic Attack or Minor Stroke: Prevalence, Evolution and Predictors. Sci Rep. 2019;9(1):16248. https://doi.org/10.1038/s41598-019-52721-5.Croot EJ., Ryan T.W., Read J., Campbell F., O'Cathain A., Venables G. Transient ischaemic attack: a qualitative study of the long term consequences for patients. BMC Fam Pract. 2014;15:174. https://doi.org/10.1186/s12875-014-0174-9.Croot EJ., Ryan T.W., Read J., Campbell F., O'Cathain A., Venables G. Transient ischaemic attack: a qualitative study of the long term consequences for patients. BMCFam Pract. 2014;15:174. https://doi.org/10.1186/s12875-014-0174-9.Spurgeon L., James G., Sackley C. Subjective experiences of transient ischaemic attack: a repertory grid approach. Disabil Rehabil. 2013;35(26):2205-2212. https://doi.org/10.3109/09638288.2013.774062.Spurgeon L., James G., Sackley C. Subjective experiences of transient ischaemic attack: a repertory grid approach. Disabil Rehabil. 2013;35(26):2205-2212. https://doi.org/10.3109/09638288.2013.774062.Gibson J., Watkins C. People's experiences of the impact of transient ischaemic attack and its consequences: qualitative study. J AdvNurs. 2012;68(8):1707-1715. https://doi.org/10.1111/j.1365-2648.2011.05849.x.Gibson J., Watkins C. People's experiences of the impact of transient ischaemic attack and its consequences: qualitative study. J Adv Nurs. 2012;68(8):1707-1715. https://doi.org/10.1111/j.1365-2648.2011.05849.x.Green T.L., King K.M. Experiences of male patients and wife-caregivers in the first year post-discharge following minor stroke: a descriptive qualitative study. Int J Nurs Stud. 2009;46(9):1194-1200. https://doi.org/10.1016/j.ijnurstu.2009.02.008.Green T.L., King K.M. Experiences of male patients and wife-caregivers in the first year post-discharge following minor stroke: a descriptive qualitative study. Int J Nurs Stud. 2009;46(9):1194-1200. https://doi.org/10.1016/j.ijnurstu.2009.02.008.Taule T., Raheim M. Life changed existentially. a qualitative study of experiences at 6-8 months after mild stroke. Disabil Rehabil. 2014;36(25):2107-2119. https://doi.org/10.3109/09638288.2014.904448.Taule T., Raheim M. Life changed existentially: a qualitative study of experiences at 6-8 months after mild stroke. Disabil Rehabil. 2014;36(25):2107-2119. https://doi.org/10.3109/09638288.2014.904448.Easton J.D., Saver J.L., Albers G.W.. 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):2276-2293. https://doi.org/10.1161/STROKEAHA.108.192218.Easton J.D., Saver J.L., Albers G.W., 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):2276-2293. https://doi.org/10.1161/STROKEAHA.108.192218.Hoshino T., Mizuno S., Shimizu S., Uchiyama S. Clinical features and functional outcome of stroke after transient ischemic attack. J Stroke Cerebrovasc Dis. 2013;22(3):260-266. https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.08.010.Hoshino T., Mizuno S., Shimizu S., Uchiyama S. Clinical features and functional outcome of stroke after transient ischemic attack. J Stroke Cerebrovasc Dis. 2013;22(3):260-266. httpsv7doi.org/10.1016/j.jstrokecerebrovasdis.2011.08.010.Deijle IA., Van Schaik S.M., Van Wegen E.E., Weinstein H.C., Kwakkel G., Van den Berg-Vos R.M. Lifestyle Interventions to Prevent Cardiovascular Events After Stroke and Transient Ischemic Attack: Systematic Review and Meta-Analysis. Stroke. 2017;48(1):174-179. https://doi.org/10.1161/STROKEAHA.116.013794.Deijle I.A., Van Schaik S.M., Van Wegen E.E., Weinstein H.C., Kwakkel G., Van den Berg-Vos R.M. Lifestyle Interventions to Prevent Cardiovascular Events After Stroke and Transient Ischemic Attack: Systematic Review and Meta-Analysis. Stroke. 2017;48(1):174-179. https://doi.org/10.1161/STROKEAHA.116.013794.Faulkner J., McGonigal G., Woolley B., Stoner L., Wong L., Lambrick D. A randomized controlled trial to assess the psychosocial effects of early exercise engagement in patients diagnosed with transient ischaemic attack and mild, non-disabling stroke. Clin Rehabil. 2015;29(8):783-794. https://doi.org/10.1177/0269215514555729.Faulkner J., McGonigal G., Woolley B., Stoner L., Wong L., Lambrick D. A randomized controlled trial to assess the psychosocial effects of early exercise engagement in patients diagnosed with transient ischaemic attack and mild, non-disabling stroke. Clin Rehabil. 2015;29(8):783-794. https://doi.org/10.1177/0269215514555729.Faux S.G., Arora P., Shiner C.T., Thompson-Butel A.G., Klein L.A. Rehabilitation and education are underutilized for mild stroke and TIA sufferers. Disabil Rehabil. 2018;40(12):1480-1484. https://doi.org/10.1080/09638288.2017.1295473.Faux S.G., Arora P., Shiner C.T., Thompson-Butel A.G., Klein L.A. Rehabilitation and education are underutilized for mild stroke and TIA sufferers. Disabil Rehabil. 2018;40(12):1480-1484. https://doi.org/10.1080/09638288.2017.1295473.Heron N., Kee F., Cardwell C., Tully MA., Donnelly M.. Cupples M.E. Secondary prevention lifestyle interventions initiated within 90 days after TIA or ‘minor' stroke: a systematic review and meta-analysis of rehabilitation programmes. Br J Gen Pract. 2017;67(654):e57-e66. https://doi.org/10.3399/bjgp16X688369.Heron N., Kee F., Cardwell C., Tully M.A., Donnelly M., Cupples M.E. Secondary prevention lifestyle interventions initiated within 90 days after TIA or ‘minor' stroke: a systematic review and meta-analysis of rehabilitation programmes. Br J Gen Pract. 2017;67(654):e57-e66. https://doi.org/10.3399/bjgp16X688369.Marzolini S., Danells C., Oh P.I., Jagroop D., Brooks D. Feasibility and Effects of Cardiac Rehabilitation for Individuals after Transient Ischemic Attack. J Stroke Cerebrovasc Dis. 2016;25(10):2453-2463. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.06.018.Marzolini S., Danells C., Oh P.I., Jagroop D., Brooks D. Feasibility and Effects of Cardiac Rehabilitation for Individuals after Transient Ischemic Attack. J Stroke Cerebrovasc Dis. 2016;25(10):2453-2463. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.06.018.Woolley B., Stoner L., Lark S., Wong L., Lanford J., Faulkner J. Effect of early exercise engagement on arterial stiffness in patients diagnosed with a transient ischaemic attack. J Hum Hypertens. 2015;29(2):87-91. https://doi.org/10.1038/jhh.2014.56.Woolley B., Stoner L., Lark S., Wong L., Lanford J., Faulkner J. Effect of early exercise engagement on arterial stiffness in patients diagnosed with a transient ischaemic attack. J Hum Hypertens. 2015;29(2):87-91. https://doi.org/10.1038/jhh.2014.56.Boss H.M.,Van Schaik S.M., Deijle IA., de Melker E.C., van den Berg B.T., Scherder EJ. et al. A randomised controlled trial of aerobic exercise after transient ischaemic attack or minor stroke to prevent cognitive decline: the MoveIT study protocol. BMJ Open. 2014;4(12):e007065. https://doi.org/10.1136/bmjopen-2014-007065.Boss H.M.,Van Schaik S.M., Deijle I.A., de Melker E.C., van den Berg B.T., Scherder EJ. et al. A randomised controlled trial of aerobic exercise after transient ischaemic attack or minor stroke to prevent cognitive decline: the MoveIT study protocol. BMJ Open. 2014;4(12):e007065. https://doi.org/10.1136/bmjopen-2014-007065.Kamm C.P., Schmid J.P., Muri R.M., Mattle H.P., Eser P., Saner H. Interdisciplinary cardiovascular and neurologic outpatient rehabilitation in patients surviving transient ischemic attack or stroke with minor or no residual deficits. Arch Phys Med Rehabil. 2014;95(4):656-662. https://doi.org/10.1016/j.apmr.2013.10.013.Kamm C.P., Schmid J.P., Muri R.M., Mattle H.P., Eser P, Saner H. Interdisciplinary cardiovascular and neurologic outpatient rehabilitation in patients surviving transient ischemic attack or stroke with minor or no residual deficits. Arch Phys Med Rehabil. 2014;95(4):656-662. https://doi.org/10.1016/j.apmr.2013.10.013.Ihle-Hansen H., Thommessen B., Fagerland M.W., Oksengard A.R., Wyller T.B., Engedal K., Fure B. Effect on anxiety and depression of a multifactorial risk factor intervention program after stroke and TIA: a randomized controlled trial. Aging Ment Health. 2014;18(5):540-546. https://doi.org/10.1080/13607863.2013.824406.Ihle-Hansen H., Thommessen B., Fagerland M.W., Oksengard A.R., Wyller T.B., Engedal K., Fure B. Effect on anxiety and depression of a multifactorial risk factor intervention program after stroke and TIA: a randomized controlled trial. Aging Ment Health. 2014;18(5):540-546. https://doi.org/10.1080/13607863.2013.824406.Mellor R.M., Bailey S., Sheppard J., Carr P, Quinn T., Boyal A. et al. Decisions and delays within stroke patients' route to the hospital: a qualitative study. Ann Emerg Med. 2015;65(3):279-287.e3. https://doi.org/10.1016/j.annemergmed.2014.10.018.Mellor R.M., Bailey S., Sheppard J., Carr P, Ouinn T., Boyal A. et al. Decisions and delays within stroke patients' route to the hospital: a qualitative study. Ann Emerg Med. 2015;65(3):279-287.e3. https://doi.org/10.1016/j.annemergmed.2014.10.018.Mc Sharry J., Baxter A., Wallace L.M., Kenton A., Turner A., French D.P. Delay in seeking medical help following Transient Ischemic Attack (TIA) or “ministroke”: a qualitative study. PLoS One. 2014;9(8):e104434. https://doi.org/10.1371/journal.pone.0104434.Mc Sharry J., Baxter A., Wallace L.M., Kenton A., Turner A., French D.P. Delay in seeking medical help following Transient Ischemic Attack (TIA) or “mini-stroke": a qualitative study. PLoS One. 2014;9(8):e104434. https://doi.org/10.1371/journal.pone.0104434.Franzen-Dahlin A., Laska A.C. Gender differences in quality of life after stroke and TIA: a cross-sectional survey of out-patients. J Clin Nurs. 2012;21 (15-16):2386-2391. https://doi.org/10.1111/j.1365-2702.2011.04064.x.Franzen-Dahlin A., Laska A.C. Gender differences in quality of life after stroke and TIA: a cross-sectional survey of out-patients. J Clin Nurs. 2012;21 (15-16):2386-2391. https://doi.org/10.1111/j.1365-2702.2011.04064.x.Brouwer-Goossensen D., van Genugten L., Lingsma H.F., Dippel D.W.J., Koudstaal PJ., den Hertog H.M. Self-efficacy for health-related behaviour change in patients with TIA or minor ischemic stroke. Psychol Health. 2018;33(12):1490-1501. https://doi.org/10.1080/08870446.2018.1508686.Brouwer-Goossensen D., van Genugten L., Lingsma H.F., Dippel D.WJ., Koudstaal PJ., den Hertog H.M. Self-efficacy for health-related behaviour change in patients with TIA or minor ischemic stroke. Psychol Health. 2018;33(12):1490-1501. https://doi.org/10.1080/08870446.2018.1508686.Kamara S., Singh S. What are the patient-held illness beliefs after a transient ischaemic attack, and do they determine secondary prevention activities: an exploratory study in a North London General Practice. Prim Health Care Res Dev. 2012;13(2):165-174. https://doi.org/10.1017/S146342361100051X.Kamara S., Singh S. What are the patient-held illness beliefs after a transient ischaemic attack, and do they determine secondary prevention activities: an exploratory study in a North London General Practice. Prim Health Care Res Dev. 2012;13(2):165-174. https://doi.org/10.1017/S146342361100051X.Широков ЕА. Первичная профилактика ишемического инсульта: антитромботическая терапия. Лечащий врач. 2015;(5):25-28. Режим доступа: https/Mww.lvrach.ru/2015/05/15436221.Shirokov E.A. Primary prevention of ischemic stroke: anti-thrombotic therapy. Lechaschi Vrach. 2015;(5):25-28. (In Russ.) Available at: https://www.lvrach.ru/2015/05/15436221.Таирова РТ. Особенности фармакологического действия и применения дипиридамола для вторичной профилактики ишемического инсульта. Consilium Medicum. 2017;19(2-3):15-18. Режим доступа: https://cyberleninka.ru/article/n/osobennosti-farmakologicheskogo-deystviya-i-primeneniya-dipiridamola-dlya-vtorichnoy-profilaktiki-ishemicheskogo-insulta.Tairova R.T. Features of pharmacological action and the use of dipyridamole for secondary prevention of ischemic stroke. Consilium Medicum. 2017;19(2-3):15-18. (In Russ.) Available at: https://cyberleninka.ru/article/n/osobennosti-farmakologicheskogo-deystviya-i-primeneniya-dipiridamola-dlya-vtorichnoy-profilaktiki-ishemicheskogo-insulta.Wu C.M., McLaughlin K., Lorenzetti D.L., Hill M.D., Manns BJ., Ghali W.A. Early risk of stroke after transient ischemic attack: a systematic review and metaanalysis. Arch Intern Med. 2007;167(22):2417-2422. https://doi.org/0.1001/archinte.167.22.2417.Wu C.M., McLaughlin K., Lorenzetti D.L., Hill M.D., Manns BJ., Ghali W.A. Early risk of stroke after transient ischemic attack: a systematic review and meta-analysis. Arch Intern Med. 2007;167(22):2417-2422. https://doi.org/0.1001/archinte.167.22.2417.

The authors declare that there are no conflicts of interest present.