Journal of Biomedical and Translational Research

Research Institute of Veterinary Medicine Chungbuk National University (충북대학교 동물의학연구소)
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Clinical characteristics and outcomes in patients with lesion-positive transient ischemic attack

  • Kang, Su-Jeong (Department of Neurology, Chungbuk National University College of Medicine and Medical Research Institute, Chungbuk National University Hospital) ;
  • Lee, Sang-Gil (Department of Neurology, Chungbuk National University College of Medicine and Medical Research Institute, Chungbuk National University Hospital) ;
  • Yum, Kyu Sun (Department of Neurology, Chungbuk National University College of Medicine and Medical Research Institute, Chungbuk National University Hospital) ;
  • Kim, Ji-Seon (Department of Neurology, Chungbuk National University College of Medicine and Medical Research Institute, Chungbuk National University Hospital) ;
  • Lee, Sung-Hyun (Department of Neurology, Chungbuk National University College of Medicine and Medical Research Institute, Chungbuk National University Hospital) ;
  • Lee, Sang-Soo (Department of Neurology, Chungbuk National University College of Medicine and Medical Research Institute, Chungbuk National University Hospital) ;
  • Shin, Dong-Ick (Department of Neurology, Chungbuk National University College of Medicine and Medical Research Institute, Chungbuk National University Hospital)
  • Received : 2018.09.27
  • Accepted : 2018.12.24
  • Published : 2018.12.31
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Abstract

Transient ischemic attack (TIA) indicates high risk for major stroke and is considered a medical emergency. Diffusion-weighted imaging (DWI) enables detection of acute ischemic lesions. The clinical significance of DWI positive lesions in TIA is obscure and its prevalence, clinical features are not established. Therefore, we performed a clinical, etiological and prognostic analysis through a cross-sectional analysis of 235 TIA patients, grouped according to presence of DWI lesion. Clinical features, underlying risk factors for stroke, outcome and rate of recurrence were analyzed. 3 months follow-up of modified Rankin Scales (mRS) were done with telephone survey. DWI positive lesions were present in 14.0% of patients. Etiological factors significantly associated with DWI lesions in TIA patients were male sex (p = 0.038), stroke history (p = 0.012) and atrial fibrillation (p < 0.001). Presence of at least one medium or high risk of cardioembolism from TOAST classification were not associated with lesions when excluding association to atrial fibrillation (p = 0.108). Clinical features showed no significant difference. Whether the patients had lesion-positive DWI was not related to an increase in mRS score during the hospital stay or at the 3-month follow-up after discharge. Future studies should include multi-center samples with large numbers, considering each unique medical environment. Routine acquisition of follow-up DWI for proper evaluation of the tissue-based definition of TIA should also be considered.

Keywords

References

  1. Hill MD, Yiannakoulias N, Jeerakathil T, Tu JV, Svenson LW, Schopflocher DP. The high risk of stroke immediately after transient ischemic attack: a populationbased study. Neurology 2004;62:2015-2020. https://doi.org/10.1212/01.WNL.0000129482.70315.2F
  2. Nguyen-Huynh MN, Johnston SC. Evaluation and management of transient ischemic attack: an important component of stroke prevention. Nat Rev Cardiol 2007;4:310-318. https://doi.org/10.1038/ncpcardio0889
  3. Giles MF, Albers GW, Amarenco P, Arsava EM, Asimos AW, Ay H, Calvet D, Coutts SB, Cucchiara BL, Demchuk AM, Johnston SC, Kelly PJ, Kim AS, Labreuche J, Lavallee PC, Mas JL, Merwick A, Olivot JM, Purroy F, Rosamond WD, Sciolla R, Rothwell PM. Early stroke risk and ABCD2 score performance in tissuevs time-defined TIA: a multicenter study. Neurology 2011;77:1222-1228. https://doi.org/10.1212/WNL.0b013e3182309f91
  4. The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators. J Clin Epidemiol 1988;41:105-114. https://doi.org/10.1016/0895-4356(88)90084-4
  5. Adams HP, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks EFM. Guidelines for the early management of adults with ischemic stroke. Circulation 2007;115:e478-e534.
  6. Yilmaz U. Diffusion-weighted imaging in acute stroke. Radiologe 2015;55:771-774. https://doi.org/10.1007/s00117-015-0002-9
  7. Calvet D, Touze E, Oppenheim C, Turc G, Meder JF, Mas JL. DWI lesions and TIA etiology improve the prediction of stroke after TIA. Stroke 2009;40:187-192. https://doi.org/10.1161/STROKEAHA.108.515817
  8. Coutts SB, Simon JE, Eliasziw M, Sohn CH, Hill MD, Barber PA, Palumbo V, Kennedy J, Roy J, Gagnon A, Scott JN, Buchan AM, Demchuk AM. Triaging transient ischemic attack and minor stroke patients using acute magnetic resonance imaging. Ann Neurol 2005;57:848-854. https://doi.org/10.1002/ana.20497
  9. Purroy F, Montaner J, Rovira A, Delgado P, Quintana M, Alvarez-Sabin J. Higher risk of further vascular events among transient ischemic attack patients with diffusion-weighted imaging acute ischemic lesions. Stroke 2004;35:2313-2319. https://doi.org/10.1161/01.STR.0000141703.21173.91
  10. Gon Y, Sakaguchi M, Okazaki S, Mochizuki H, Kitagawa K. Prevalence of positive diffusion-weighted imaging findings and ischemic stroke recurrence in transient ischemic attack. J Stroke Cerebrovasc Dis 2015;24:1000-1007. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.12.023
  11. Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Feldmann E, Hatsukami TS, Higashida RT, Johnston SC, Kidwell CS, Lutsep HL, Miller E, Sacco RL. 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;40:2276-2293. https://doi.org/10.1161/STROKEAHA.108.192218
  12. Sorensen AG, Ay H. Transient ischemic attack: definition, diagnosis, and risk stratification. Neuroimaging Clin N Am 2011;21:303-313. https://doi.org/10.1016/j.nic.2011.01.013
  13. Mohr JP. History of transient ischemic attack definition. Front Neurol Neurosci 2014;33:1-10.
  14. Siket MS, Edlow J. Transient ischemic attack: an evidence-based update. Emerg Med Pract 2013;15:1-26.
  15. Uno H, Taguchi A, Oe H, Nagano K, Yamada N, Moriwaki H, Naritomi H. Relationship between detectability of ischemic lesions by diffusion-weighted imaging and embolic sources in transient ischemic attacks. Eur Neurol 2008;59:38-43. https://doi.org/10.1159/000109259
  16. Brazzelli M, Chappell FM, Miranda H, Shuler K, Dennis M, Sandercock PAG, Muir K, Wardlaw JM. Diffusion-weighted imaging and diagnosis of transient ischemic attack. Ann Neurol 2014;75:67-76. https://doi.org/10.1002/ana.24026
  17. Wardlaw J, Brazzelli M, Miranda H, Chappell F, Mc-Namee P, Scotland G, Quayyum Z, Martin D, Shuler K, Sandercock P, Dennis M. An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke. a systematic review, meta-analysis and economic evaluation. Health Technol Assess 2014;18:1-368.
  18. Anticoli S, Pezzella FR, Pozzessere C, Gallelli L, Bravi MC, Caso V, Siniscalchi A. Transient ischemic attack fast-track and long-term stroke risk: Role of diffusionweighted magnetic resonance imaging. J Stroke Cerebrovasc Dis 2015;24:2110-2116. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.05.016
  19. Vilanova MB, Mauri-Capdevila G, Sanahuja J, Quilez A, Pinol-Ripoll G, Begue R, Gil MI, Codina-Barios MC, Benabdelhak I, Purroy F. Prediction of myocardial infarction in patients with transient ischaemic attack. Acta Neurol Scand 2015;131:111-119.
  20. Scheef B, Al-Khaled M. Atrial fibrillation in patients with transient ischemic attack in accordance with the tissue-based definition. J Vasc Interv Neurol 2016;9:23-27.
  21. Chang JY, Kim dH, Chung JH, Yum KS, Hong JH, Han MK. Hospital-based prospective registration of acute transient ischemic attack and moncerebrovascular events in Korea. J Stroke Cerebrovasc Dis 2015;24:1803-1810. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.04.007
  22. Redgrave JNE, Coutts SB, Schulz UG, Briley D, Rothwell PM. Systematic review of associations between the presence of acute ischemic lesions on diffusion-weighted imaging and clinical predictors of early stroke risk after transient ischemic attack. Stroke 2007;38:1482-1488. https://doi.org/10.1161/STROKEAHA.106.477380
  23. Hama Y, Uehara T, Ohara T, Kimura K, Okada Y, Hasegawa Y, Tanahashi N, Suzuki A, Takagi S, Nakagawara J, Arii K, Nagahiro S, Ogasawara K, Nagao T, Uchiyama S, Matsumoto M, Iihara K, Toyoda K, Minematsu K. Clinical characteristics of transient ischemic attack patients with atrial fibrillation: analyses of a multicenter retrospective study. Cerebrovasc Dis Extra 2015;5:84-90.
  24. Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35-41. https://doi.org/10.1161/01.STR.24.1.35
  25. Quinn TJ, Dawson J, Walters MR, Lees KR. Reliability of the modified rankin scale. A systematic review 2009;40:3393-3395. https://doi.org/10.1161/STROKEAHA.109.557256
  26. Savio K, Pietra GLD, Oddone E, Reggiani M, Leone MA. Reliability of the modified rankin scale applied by telephone. Neurol Int 2013;5:e2. https://doi.org/10.4081/ni.2013.e2
  27. Wireklint Sundstrom B, Herlitz J, Hansson PO, Brink P. Comparison of the university hospital and county hospitals in western Sweden to identify potential weak links in the early chain of care for acute stroke: results of an observational study. BMJ Open 2015;5:e008228. https://doi.org/10.1136/bmjopen-2015-008228
  28. Uno H, Nagatsuka K, Kokubo Y, Higashi M, Yamada N, Umesaki A, Toyoda K, Naritomi H. Detectability of ischemic lesions on diffusion-weighted imaging is biphasic after transient ischemic attack. J Stroke Cerebrovasc Dis 2015;24:1059-1064. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.12.037
  29. Nah HW, Kwon SU, Kang DW, Lee DH, Kim JS. Diagnostic and prognostic value of multimodal MRI in transient ischemic attack. Int J Stroke 2014;9:895-901. https://doi.org/10.1111/ijs.12212
  30. Makin SD, Doubal FN, Dennis MS, Wardlaw JM. Clinically confirmed stroke with negative diffusion-weighted imaging magnetic resonance imaging: longitudinal study of clinical outcomes, stroke recurrence, and systematic review. Stroke 2015;46:3142-3148. https://doi.org/10.1161/STROKEAHA.115.010665