Jae-Sung Lim1, Keun-Sik Hong2, Gyeong-Moon Kim3, Oh Young Bang3, Hee-Joon Bae4, Hyung-Min Kwon1, Jong-Moo Park5, Seung-Hoon Lee6, Joung-Ho Rha7, Jaseong Koo8, Kyung-Ho Yu9, Woo-Keun Seo10, Kyung Bok Lee11, Yong-Seok Lee1. 1. Department of Neurology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea. 2. Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea. 3. Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 4. Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. 5. Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Republic of Korea. 6. Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea. 7. Department of Neurology, Inha University Hospital, Incheon, Republic of Korea. 8. Department of Neurology, Catholic University, St Mary's Hospital, Seoul, Republic of Korea. 9. Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea. 10. Department of Neurology, Korea University Guro Hospital, Seoul, Republic of Korea. 11. Department of Neurology, Soonchunhyang University Hospital, Seoul, Republic of Korea.
Abstract
IMPORTANCE: The risk of early recurrent stroke after transient ischemic attack (TIA) may be modifiable by optimal treatment. Although ABCD2 scores, diffusion-weighted imaging lesions, and large artery stenosis are well known to predict early stroke recurrence, other neuroimaging parameters, such as cerebral microbleeds (CMBs), have not been well explored in patients with TIA. OBJECTIVE: To determine the rate of early recurrent stroke after TIA and its neuroimaging predictors. DESIGN, SETTING, AND PARTICIPANTS: In this hospital-based, multicenter prospective cohort study, consecutive patients with TIA were enrolled from 11 university hospitals from July 1, 2010, through December 31, 2012. Patients who were admitted within 24 hours after symptom onset and underwent diffusion-weighted imaging were included. MAIN OUTCOMES AND MEASURES: The primary end point was recurrent stroke within 90 days. Baseline demographics, clinical manifestations, neuroimaging findings, and use of antithrombotics or statins also were analyzed. RESULTS: A total of 500 patients (mean age, 64 years; male, 291 [58.2%]; median ABCD2 score, 4) completed 90-day follow-up with guideline-based management: antiplatelets (457 [91.4%]), anticoagulants (74 [14.8%]), and statins (345 [69.0%]). Recurrent stroke occurred in 25 patients (5.0%). Compared with patients without recurrent stroke, those with recurrent stroke were more likely to have crescendo TIA (20 [4.2%] vs 4 [16.0%], P = .03), white matter hyperintensities (146 [30.7%] vs 13 [52.0%], P = .03), and CMBs (36 [7.6%] vs 7 [28.0%], P = .003). On multivariable Cox proportional hazards analysis, CMBs remained as independent predictors for recurrent stroke (hazard ratio, 3.66; 95% CI, 1.47-9.09; P = .005). CONCLUSIONS AND RELEVANCE: Immediate and optimal management seems to modify the risk of recurrent stroke after TIA. Cerebral microbleeds may be novel predictors of stroke recurrence, which needs further validation.
IMPORTANCE: The risk of early recurrent stroke after transient ischemic attack (TIA) may be modifiable by optimal treatment. Although ABCD2 scores, diffusion-weighted imaging lesions, and large artery stenosis are well known to predict early stroke recurrence, other neuroimaging parameters, such as cerebral microbleeds (CMBs), have not been well explored in patients with TIA. OBJECTIVE: To determine the rate of early recurrent stroke after TIA and its neuroimaging predictors. DESIGN, SETTING, AND PARTICIPANTS: In this hospital-based, multicenter prospective cohort study, consecutive patients with TIA were enrolled from 11 university hospitals from July 1, 2010, through December 31, 2012. Patients who were admitted within 24 hours after symptom onset and underwent diffusion-weighted imaging were included. MAIN OUTCOMES AND MEASURES: The primary end point was recurrent stroke within 90 days. Baseline demographics, clinical manifestations, neuroimaging findings, and use of antithrombotics or statins also were analyzed. RESULTS: A total of 500 patients (mean age, 64 years; male, 291 [58.2%]; median ABCD2 score, 4) completed 90-day follow-up with guideline-based management: antiplatelets (457 [91.4%]), anticoagulants (74 [14.8%]), and statins (345 [69.0%]). Recurrent stroke occurred in 25 patients (5.0%). Compared with patients without recurrent stroke, those with recurrent stroke were more likely to have crescendo TIA (20 [4.2%] vs 4 [16.0%], P = .03), white matter hyperintensities (146 [30.7%] vs 13 [52.0%], P = .03), and CMBs (36 [7.6%] vs 7 [28.0%], P = .003). On multivariable Cox proportional hazards analysis, CMBs remained as independent predictors for recurrent stroke (hazard ratio, 3.66; 95% CI, 1.47-9.09; P = .005). CONCLUSIONS AND RELEVANCE: Immediate and optimal management seems to modify the risk of recurrent stroke after TIA. Cerebral microbleeds may be novel predictors of stroke recurrence, which needs further validation.
Authors: Andreas Charidimou; Sara Shams; Jose R Romero; Jie Ding; Roland Veltkamp; Solveig Horstmann; Gudny Eiriksdottir; Mark A van Buchem; Vilmundur Gudnason; Jayandra J Himali; M Edip Gurol; Anand Viswanathan; Toshio Imaizumi; Meike W Vernooij; Sudha Seshadri; Steven M Greenberg; Oscar R Benavente; Lenore J Launer; Ashkan Shoamanesh Journal: Int J Stroke Date: 2018-01-17 Impact factor: 5.266