Transient Ischemic Attack Fast-track and Long-Term Stroke Risk: Role of Diffusion-Weighted Magnetic Resonance Imaging

Anticoli, Sabrina; Pezzella, Francesca Romana; Pozzessere, Claudio; Gallelli, Luca; Bravi, M.; Caso, Valeria; Siniscalchi, Antonio

doi:10.1016/j.jstrokecerebrovasdis.2015.05.016

Cited by 22 publications

(17 citation statements)

References 29 publications

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“…In the present study, we found that the risk of stroke is much higher in TIA patients with positive DWI, sharing a similar result with other studies published [14][15][16] . So far, it is still not clear which population could gain more benefits from DAPT.…”

Section: Discussionsupporting

confidence: 93%

Dual antiplatelet therapy reduced stroke risk in transient ischemic attack with positive diffusion weighted imaging

Pei

Chen

Fang

et al. 2020

Sci Rep

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Dual antiplatelet therapy (DAPT) reduced stroke risk in high-risk transient ischemic attack (TIA) patients assessed by ABCD2 score. Patients with positive diffusion-weighted imaging (DWI) were identified as imaging-based high-risk. The present study aims to investigate whether DAPT could reduce stroke risk in TIA with DWI positive. The study enrolled TIA patients within 72 h of onset from the prospective TIA database of the First Affiliated Hospital of Zhengzhou University. The predictive outcome was ischemic stroke at 90-day. The relationship between DAPT and stroke was analyzed in a cox proportional hazards model. The Kaplan–Meier curves of TIA patients with DAPT and monotherapy were plotted. Total of 661 TIA patients were enrolled, 279 of whom were DWI positive and 281 used DAPT. The 90-day stroke risk was higher in patients used monotherapy than those used DAPT in TIA with positive DWI (23.7% vs. 13.4%, p = 0.029). DAPT was associated with reduced stroke risk in TIA patients with positive DWI (hazard ratio [HR] = 0.54; 95% confidence interval [CI], 0.30–0.97; p = 0.037). However, the benefit didn’t exist in TIA patients with negative DWI (HR = 0.43; 95% CI, 0.14–1.33; p = 0.142). Early use of DAPT reduced stroke risk in TIA patients with positive DWI.

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Section: Discussionsupporting

confidence: 93%

Dual antiplatelet therapy reduced stroke risk in transient ischemic attack with positive diffusion weighted imaging

Pei

Chen

Fang

et al. 2020

Sci Rep

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“…As for DWI lesions for stroke risk from 1 to 5 years, the study of Whilst Anticoli did not record any difference in stroke risk in patients with positive DWI lesions. This study showed the long-term followup study in TIA patients documents that both positive and negative DWI patients treated with fasttrack had similar long-term risks of stroke [21]. We found that patients with acute DWI lesions had more severe vascular stenosis and thicker maximal plaque.…”

Section: Discussionsupporting

confidence: 58%

“…Early brain MRI examination is warranted in these patients. The use of DWI in all TIA patient assessments improved risk stratification from day 7 up to 3 months [21].…”

Section: Discussionmentioning

confidence: 99%

Dysphasia and platelet count associated with diffusion-weighted images lesions in patients with a clinical diagnosis of transient ischemic attack

Jia

Song

Yuan

2019

Preprint

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Background Magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) is a mandatory tool in the diagnosis of a transient ischemic attack (TIA). Many patients cannot have an MRI in time. The clinical characteristics associated with DWI positivity after TIA are of great significance for the early diagnosis and urgent intervention of TIA and cerebral infarction. This study was conducted to investigate the clinical characteristics associated with DWI lesions in TIA patients. Methods We retrospectively identified patients who met the criteria of symptom duration <24 hours for a clinical diagnosis of TIA, and then screened out 302 patients underwent DWI within 7 days of admission. The patients were divided into DWI positive and DWI negative group. The clinical characteristics including risk factors, clinical manifestation, the laboratory blood tests, the auxiliary examination and the TIA scores were compared between the two groups. We aimed to identify the clinical characteristics associated with DWI lesions using logistic regression analysis. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were calculated to compare the predictive value of various scores such as ABCD2, ABCD3, ABCD3I, Dawson score and the Diagnosis of TIA (DOT) score for DWI lesions in TIA patients. Results A total of 302 patients (mean age, 62(54,70) years; 67.2 % men) were enrolled in this study. There were 89(29.5%) patients with DWI positivity. Logistic regression analysis showed that the clinical characteristics associated with DWI lesions were dysphasia ([OR] 2.129; 95%[CI] 1.215-3.729) and platelet count ([OR] 0.993; 95%[CI] 0.988-0.999). The AUCs [95%CI] for Dawson score was 0.610[0.543-0.678] and the DOT score was 0.625[0.559-0.691]. Conclusion DWI lesions were detected in 29.5% of patients with classically defined TIA and were associated with dysphasia and platelet count. Dawson score and DOT score seem to have the predictability of DWI lesions in TIA patients.

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“…TIA is a transient neurologic deficit with a rapid recovery lasting within a few minutes or less than 24 hours that is attributed to focal ischemia of the brain or retina [ 6 ]. DWI is sensitive in the detection of acute events of small and early infarcts, and a positive DWI lesion is a reliable predictor or recurrent stroke [ 7 ]. About 40 % of patients with TIA have been reported to have a positive DWI lesions, however, our patient was negative on DWI [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…DWI is sensitive in the detection of acute events of small and early infarcts, and a positive DWI lesion is a reliable predictor or recurrent stroke [ 7 ]. About 40 % of patients with TIA have been reported to have a positive DWI lesions, however, our patient was negative on DWI [ 7 ]. TIA is usually caused by a small emboli and is often associated with hypertension, heart disease, hyperlipidemia and diabetes mellitus [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Transient cortical visual impairment after video-assisted thoracic surgery: a case report

Yang

Hwang

2015

BMC Ophthalmol

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BackgroundVisual loss associated with thoracic surgery has been reported mostly after coronary angiography or bypass surgery. The position of video-assisted thoracic surgery (VATS) is usually lateral, thus not compressive to the globe. Visual loss after VATS has not been reported. Herein we report a patient without any cardiovascular risk factors who experienced transient cortical blindness after an uneventful VATS.Case presentationA 40-year-old man noticed a visual loss at the recovery room after VATS. He showed normal pupillary reflex, normal optic disc appearance, and homonymous hemianopia respecting the vertical meridian, thus was typical for cortical visual impairment.ConclusionsTransient cortical visual impairment could be encountered after an uneventful VATS in a patient without any cardiovascular risk factors.

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Transient Ischemic Attack Fast-track and Long-Term Stroke Risk: Role of Diffusion-Weighted Magnetic Resonance Imaging

Cited by 22 publications

References 29 publications

Dual antiplatelet therapy reduced stroke risk in transient ischemic attack with positive diffusion weighted imaging

Dual antiplatelet therapy reduced stroke risk in transient ischemic attack with positive diffusion weighted imaging

Dysphasia and platelet count associated with diffusion-weighted images lesions in patients with a clinical diagnosis of transient ischemic attack

Transient cortical visual impairment after video-assisted thoracic surgery: a case report

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