CT identifies patients with TIA who are at high risk of stroke

A new study shows that computed tomography (CT) results suggestive of acute ischemia can identify patients at high risk of impending stroke in patients
with transient ischaemic attack (TIA) or non-disabling stroke.

The researchers concluded: "Acute ischemia is associated with a high risk of stroke after TIA/nondisabling stroke, particularly at day 2 after acute ischemia and TIA/nondisabling stroke, in addition to an increased
risk of chronic ischemia and microangiopathy.
" ”

Dr.
Jason K.
Wasserman of the University of Ottawa, Ontario, Canada, conducted the study, and the findings were published online Dec.
4 in
the journal Stroke.
[Related: Stroke 2014 Dec 4]

Study co-author Dr.
Jeffrey J Perry of the Ottawa Hospital Health Research Institute, told Medscape Medical News: "Neuroimaging needs to be performed
within 24 hours of TIA/non-disabling stroke.
If there are acute changes, particularly if they are associated with past impairment or microvascular disease, the patient needs to switch immediately from focusing on stroke physicians to preventing subsequent
strokes.
”

Dr.
Perry noted that current treatment of TIA/non-disabling stroke patients varies widely
.
"In Canada, most patients are treated
as outpatients," he said.
Most patients have follow-up, but this can take days or weeks, and many have already had a second stroke before they see again, so we say we need to prioritize certain patients – those who are associated with high risk of CT changes
.
These patients require stroke care while they are still in the emergency department
.
”

He explained that it was previously known that patients with acute ischemia are at higher risk, but the new point of this study is the degree of
risk.

The stakes are higher than previously thought

"If ischemia is associated with previous disease areas and small vessel lesions, the risk [of stroke] is much
greater than we previously thought," he said.
If these patients present and are treated appropriately, stroke deaths and disability
can be reduced.
”

The study included a total of 2028 patients with TIA or non-disabling stroke, all of whom underwent CT within 24 hours
.
The results showed that 814 patients had ischemic changes
in CT.
The incidence of stroke on day 2 and day 90 was 1.
5% and 3.
4%, respectively
.

The risk of stroke is higher if baseline CT shows only acute ischaemia (10.
6%), and higher if accompanied by chronic ischaemia (17.
4%) or microangiopathy (17.
6%)
.
All three risk factors were associated with
a stroke incidence of 25.
0%.

The researchers reported that 4.
2% of patients had acute ischemia, and these patients had a more than 3-fold higher incidence of stroke within 2 days than those without acute ischemia
.
This confirms that many early stroke risks appear to be associated with
patients with non-disabling stroke progression.

"For the first time, we found that those with acute ischemia, chronic ischemia and/or microangiopathy had the highest risk within 2 days, while those with only acute ischemia or those with acute ischemia and chronic ischemia and/or microangiopathy had the highest
risk within 90 days.
"

They added: "These factors are independent correlated factors that were previously associated with TIA/non-disabling stroke after stroke and therefore add value
to the available clinical data.
" ”

They note that noting that urgent imaging data were added to the ABCD2 (age, blood pressure, TIA clinical features, duration, and diabetes mellitus) score to form a novel ABCD2I scoring protocol, "Our study confirms the value
of supplementing imaging data to clinical data in predicting which patients are at high risk of stroke after TIA.
" ”

They added that while most patients with CT showing ischemia or microangiopathy had higher ABCD2 scores than those without similar lesions, many patients who still developed stroke were still classified as low or moderate risk
.