CT/CTA predicted recurrent stroke in patients with TIA, minor stroke

Coutts SB. Stroke. 2012;doi:10.1161/STROKEAHA.111.637421.

Issue: March 2012

In patients with transient ischemic attack and minor stroke, use of CT/CTA in an early assessment of the intracranial and extracranial vasculature predicted recurrent stroke, according to recent study results.

During 29 months, researchers enrolled 510 patients (median age, 9 years) with high-risk TIA focal weakness or speech disturbance lasting at least 5 minutes or minor ischemic stroke (NIH Stroke Scale score ≤3). Patients underwent CT/CTA and subsequent MRI. Using standard clinical variable and predefined abnormalities on CT/CTA and MRI, the researchers assessed recurrent stroke risk within 90 days.

Overall, study results showed 36 recurrent strokes (7.1%; 95% CI, 5.0-9.6) with a median time to the event of 1 day, a median time from onset to CTA of 5.5 hours and to MRI of 17.5 hours. Before any recurrent event, 82% of patients had MRI, 58% of whom were diffusion-weighted imaging-positive (95% CI, 53-63).

Researchers found a final diagnosis of ischemic stroke (n=237) or TIA (n=232) in 92% of patients. Eighty-five percent of patients were treated with aspirin for more than 1 day, 34% with clopidogrel, 29% with aspirin and clopidogrel and 60% with a statin. Only 1% of patients died during 90-day follow-up.

Study results showed ongoing symptoms at first assessment (HR=2.2; 95% CI, 1.02-4.9), CT/CTA abnormalities (HR=4.0; 95% CI, 2.0-8.5) and diffusion-weighted imaging positivity (HR=2.2; 95% CI, 1.05-4.7) predicted recurrent stroke. In a multivariable analysis, however, only CT/CTA abnormalities predicted recurrent stroke. Additionally, when it came to predicting recurrent stroke, researchers found no significant difference in discriminative value between CT/CTA (0.67; 95% CI, 0.59-0.76) and MRI (0.59; 95% CI, 0.52-0.67), according to a secondary analysis.

Although MRI also can identify patients at high risk for recurrent stroke, it is not always readily available in an emergency. CT/CTA, however, is readily available and a practical solution to the assessment of patients with TIA or minor stroke, according to the researchers.

“Adoption of CT/CTA into clinical practice for the assessment of patients with TIA and minor stroke identifies a high-risk group suitable for aggressive acute stroke prevention treatment,” they said. “Randomized controlled trials of treatment options in these high-risk patients with minor stroke and TIA are urgently needed.”

Disclosure: See the study for a full list of disclosures.

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