Clinical skills or high-tech MR in TIA patients: what makes the difference?
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TIA has been recently re-defined as “a transient episode of neurological dysfunction caused by ischemia without acute infarction.” The gold standard to exclude the presence of ischemic lesions is acute brain MR. However, in many clinical settings, the 24/7 availability of MR is, at best, irregular. Being so, an appropriate adoption of this definition, which excludes the presence of ischemic lesions, can only be equally irregular. Our aim was to retrospectively compare the long-term outcomes of patients receiving acute care for TIA diagnosed with the new, tissue-based definition, and those diagnosed only on symptom duration.
We analyzed 480 patients (227 males) from two centers: group 1 consisted of 162 patients with time-defined TIA; group 2 of 315 patients with negative brain DW-MRI (tissue-based TIAs). We considered the combined recurrence of TIA, stroke, myocardial infarction, and angina as endpoints.
Both groups had a similar mean follow-up duration (38.3 months vs. 37.2 months) and were comparable for vascular risk factors, clinical features, and etiology. The combined endpoint rates were 11.1% for both groups, and the rates for segregate endpoints did not differ between groups. Recurrence was correlated with atrial fibrillation, diabetes, and high diastolic blood pressure.
The long-term outcomes of TIA patients did not differ according to the definitions applied. Therein suggesting that, even without acute MRI results, a clinical diagnosis seemed to be enough to assure prompt medical treatment and similar long-term outcomes.
KeywordsTransient ischemic attack Diffusion-weighted magnetic resonance
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Lavallée PC, Meseguer E, Abboud H, Cabrejo L, Olivot JM, Simon O, Mazighi M, Nifle C, Niclot P, Lapergue B, Klein IF, Brochet E, Steg PG, Lesèche G, Labreuche J, Touboul PJ, Amarenco P (2007 Nov) A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects. Lancet Neurol 6(11):953–960CrossRefPubMedGoogle Scholar
- 2.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, American Heart Association, American Stroke Association Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular Nursing, Interdisciplinary Council on Peripheral Vascular Disease (2009) 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 40:2276–2293CrossRefPubMedGoogle Scholar
- 4.Purroy F, Jiménez Caballero PE, Gorospe A, Torres MJ, Alvarez-Sabin J, Santamarina E et al (2013) Stroke Project of the Spanish Cerebrovascular Diseases Study Group. Recurrent transient ischaemic attack and early risk of stroke: data from the PROMAPA study. J Neurol Neurosurg Psychiatry 84:596–603CrossRefPubMedGoogle Scholar
- 9.Amarenco P, Lavallée PC, Labreuche J, Albers GW, Bornstein NM, Canhão P, Caplan LR, Donnan GA, Ferro JM, Hennerici MG, Molina C, Rothwell PM, Sissani L, Školoudík D, Steg PG, Touboul PJ, Uchiyama S, Vicaut É, Wong LK, TIAregistry.org Investigators (2016) One-year risk of stroke after transient ischemic attack or minor stroke. N Engl J Med 374(16):1533–1542CrossRefPubMedGoogle Scholar
- 14.Redgrave JN, Coutts SB, Schulz UG, Briley D, Rothwell PM (2007) 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 38:1482–1488CrossRefPubMedGoogle Scholar
- 18.Wardlaw J, Brazzelli M, Miranda H, Chappell F, McNamee P, Scotland G, Quayyum Z, Martin D, Shuler K, Sandercock P, Dennis M (2014) 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 18(27):1–368 v-viCrossRefPubMedPubMedCentralGoogle Scholar