Imaging Parameters and Recurrent Cerebrovascular Events in Patients With Minor Stroke or Transient Ischemic Attack

Yaghi, Shadi; Rostanski, Sara; Boehme, Amelia K; Martin‐Schild, Sheryl; Samai, Alyana; Silver, Brian; Blum, Christina; Jayaraman, Mahesh; Siket, Matthew S.; Khan, Muhib; Furie, Karen L.; Elkind, Mitchell S.V.; Marshall, Randolph S.; Willey, Joshua Z.

doi:10.1001/jamaneurol.2015.4906

Cited by 57 publications

(46 citation statements)

References 25 publications

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“…To prove the association of BPV and END, we adopted a definition of END as a ≥1‐point increase in NIHSS score during the first 72 hours after admission. And, the rate of END was 32.5% in this study, which was consistent with the rates in previous studies . And also, our findings were similar to that in the Chungs' study .…”

Section: Discussionsupporting

confidence: 92%

“…It is reported that minor ischemic stroke and TIA account for ≈65% of all acute ischemic cerebrovascular events . Although minor stroke and TIA seem to be benign, recent studies have shown that a significant proportion of patients with steno‐occlusive arterial disease is in unstable clinical state and has high risks of recurrent cerebrovascular events or early neurological deterioration (END) in the hospital, resulting in major physical disability . Therefore, it is of great importance to identify factors associated with END in patients with acute minor stroke or TIA due to steno‐occlusive arterial disease.…”

Section: Introductionmentioning

confidence: 99%

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Acute in‐hospital blood pressure variability predicts early neurological deterioration in acute minor stroke or transient ischemic attack with steno‐occlusive arterial disease

Duan

Tao

Yang

et al. 2020

J of Clinical Hypertension

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It is generally known that acute minor stroke and transient ischemic attack (TIA) seem to be benign. However, their occurrence in patients with steno‐occlusive arterial disease may result in early neurological deterioration (END). We aimed to elucidate the effect of blood pressure variability (BPV) on the development of END. Consecutive acute minor stroke and TIA patients within 24 hours of onset were prospectively recruited from the Affiliated Hospital of Yangzhou University between Aug 2015 and Feb 2019. END was defined as an NIHSS score increased ≥1 during the first 72 hours compared with the initial NIHSS score. During this period, the mean, maximum (max), the difference between the maximum and minimum (max‐min), the SD, and coefficient of variation of BP (BPCV) were calculated. Of the 160 total patients enrolled in the study (mean age, 68.01 ± 9.33 years; 50.6% female), 52 (32.5%) patients occurred END during the first 72h after admission. To express the BPV as a categorical variable, we classified the subjects into one of four groups, representing four quartiles of BPV. In the multivariable analyses, the lowest quartiles were considered as reference groups. The results showed that patients who fell in the fourth quartile (SBPmax‐min:OR = 3.289, 95% CI 1.147‐9.430; SBPSD:OR = 3.313, 95% CI 1.041‐10.547; SBPCV:OR = 3.425, 95% CI 1.164‐10.077; DBPSD:OR = 3.124, 95% CI 1.065‐9.158) had a significantly higher risk of END after adjusting the variables (age, female, diabetes mellitus, atrial fibrillation, and CRP with P values <.1 in univariate analyses). Our study demonstrated that the acute in‐hospital BPV was associated with the development of END in acute minor stroke and TIA with steno‐occlusive arterial disease.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Acute in‐hospital blood pressure variability predicts early neurological deterioration in acute minor stroke or transient ischemic attack with steno‐occlusive arterial disease

Duan

Tao

Yang

et al. 2020

J of Clinical Hypertension

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“…We demonstrated that in patients with anterior circulation sICAS, a target mismatch profile using T max > 6 seconds and RCVE were associated only with IBZ infarcts but not with other infarct patterns. The overall event rate was higher than that observed in SAMMPRIS but is similar to that in prior real‐world studies that enrolled patients within 24 hours from symptom onset …”

Section: Discussionsupporting

confidence: 81%

Infarct Pattern, Perfusion Mismatch Thresholds, and Recurrent Cerebrovascular Events in Symptomatic Intracranial Stenosis

Yaghi

Grory

Yeatts

et al. 2019

Journal of Neuroimaging

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BACKGROUND AND PURPOSE Studies have shown an association between infarct patterns and recurrent stroke in patients with symptomatic intracranial stenosis (sICAS) but there are limited data on associations with perfusion imaging mismatch profile. We aim to determine the association between infarct pattern, optimal mismatch profile definition, and recurrent cerebrovascular events (RCVE) in patients with anterior circulation sICAS. METHODS This is a retrospective study of consecutive patients with acutely sICAS admitted to a comprehensive stroke center over 18 month's period. Patients with sICAS underwent magnetic resonance perfusion (MRP) imaging within 24 hours from admission. Infarct patterns (internal BZ [IBZ], cortical BZ [CBZ], and core/perforator [C/P]) and RCVE within 90 days, were independently adjudicated by two reviewers. We compared mismatch profiles and recurrent event rates across infarct patterns. RESULTS Twenty‐five patients met inclusion criteria; 28% had IBZ infarcts and overall RCVE rate was 32.0%. When compared to patients without IBZ infarcts, those with IBZ infarcts were more likely to have a target mismatch profile using Tmax > 6 seconds (60% vs. 6.7%, P = .007) and RCVE (62.5% vs. 11.8%, P = .01). There were no associations between CBZ and C/P infarcts and target mismatch profiles and RCVE. CONCLUSION IBZ infarcts may be a surrogate marker of distal perfusion status and RCVE risk. Larger multicenter, prospective, core‐lab blindly adjudicated studies are needed to confirm our findings.

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“…However, evidence has shown that diffusion‐weighted imaging (DWI) abnormality and carotid stenosis ≥50% portend an increased risk of stroke. A number of studies showed that ABCD3‐I score, combining imaging factors with ABCD2 score, had a relatively higher predictive value than ABCD2 score, which relied on summation of points associated with clinical factors .…”

Section: Introductionmentioning

confidence: 99%

Dual antiplatelet therapy reduced stroke risk in high‐risk patients with transient ischaemic attack assessed by ABCD3‐I score

Song

Pei

et al. 2018

Euro J of Neurology

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Background and purpose Several clinical trials have demonstrated that dual antiplatelet therapy (DAPT) benefited patients with transient ischaemic attack (TIA) with an ABCD2 score ≥4. The present study aimed to investigate whether the ABCD3‐I score could be a more appropriate tool for selection of patients with TIA to receive DAPT in real‐world settings. Methods We derived data from the TIA database of The First Affiliated Hospital of Zhengzhou University. The predictive outcome was ischaemic stroke at 90 days. The additive interaction effect was presented by the attributable proportion due to interaction. Kaplan–Meier curves were plotted to present cumulative stroke rates in different risk categories with monotherapy and DAPT. Cox proportional hazards regression was used to determine risk factors associated with stroke. Results Among 785 patients, the mean (SD) age was 56.95 (12.73) years and 77 patients (9.8%) had an ischaemic stroke at 90 days. A total of 55.8% of patients (attributable proportion due to interaction; 95% confidence interval, 20.8%–90.9%) were attributed to additive interaction of ABCD3‐I score and antiplatelet therapy. Kaplan–Meier curves showed a significant difference between patients receiving monotherapy and DAPT in high‐risk patients with TIA (P = 0.021). DAPT reduced 90‐day stroke risk in high‐risk patients with TIA as assessed independently by ABCD3‐I score (adjusted hazard ratio, 0.43; 95% confidence interval, 0.20–0.92, P = 0.031). The benefit did not exist in low‐ and medium‐risk patients by ABCD3‐I score (patients with ABCD2 score ≥ 4 or <4). Conclusions High‐risk patients with TIA assessed by ABCD3‐I score received the most pronounced clinical benefit from early use of DAPT in real‐world clinical experience.

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Imaging Parameters and Recurrent Cerebrovascular Events in Patients With Minor Stroke or Transient Ischemic Attack

Cited by 57 publications

References 25 publications

Acute in‐hospital blood pressure variability predicts early neurological deterioration in acute minor stroke or transient ischemic attack with steno‐occlusive arterial disease

Acute in‐hospital blood pressure variability predicts early neurological deterioration in acute minor stroke or transient ischemic attack with steno‐occlusive arterial disease

Infarct Pattern, Perfusion Mismatch Thresholds, and Recurrent Cerebrovascular Events in Symptomatic Intracranial Stenosis

Dual antiplatelet therapy reduced stroke risk in high‐risk patients with transient ischaemic attack assessed by ABCD3‐I score

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