Department of Vascular Neurology, UMR U1048, University of Toulouse, Toulouse, France.
Eur J Neurol. 2013 Aug;20(8):1212-7. doi: 10.1111/ene.12178. Epub 2013 May 6.
Patients with transient ischaemic attack (TIA) with a high risk of imminent stroke can be identified with the ABCD(2) score and findings on MRI and CT angiography. The predictive value of transcranial color-coded sonography (TCCS) has not been evaluated in this setting.
A retrospective analysis was conducted of patients consecutively treated for TIA or minor stroke in a TIA clinic within 24 h of symptom onset. Agreement between TCCS and MRI three-dimensional time-of-flight images for the diagnosis of proximal (internal carotid artery, vertebral artery, basilar artery, circle of Willis and main stem of the middle cerebral artery) >50% stenosis or occlusion of the intracranial symptomatic artery was evaluated. The sensitivity, specificity, predictive values and likelihood ratio of TCCS for predicting recurrent TIA/stroke at 7 days were calculated.
Of 159 patients with a TIA or minor stroke within the last 24 h, 142 had a readable acoustic temporal bone window (89.3%). TCCS and MRI were performed within 4 h of each other in 116 patients. MRI showed a symptomatic proximal intracranial steno-occlusive lesion in six patients. Agreement between MRI and TCCS was perfect (κ coefficient = 1). Recurrent TIA/stroke occurred in 10 patients (eight TIA and two minor strokes). All recurrences occurred within 24 h of symptom onset. A symptomatic proximal intracranial steno-occlusive lesion was found on TCCS in 4/10 patients with recurrence and 3/132 patients without recurrence [sensitivity 40%; specificity 97.7%; likelihood ratio 18.1; odds ratio (95% CI) adjusted for ABCD(2) score 31.5 (4.5-218.6)].
Our study shows that TCCS can be used to guide triage of patients with TIA.
通过 ABCD(2) 评分以及 MRI 和 CT 血管造影检查，可识别出即将发生卒中的短暂性脑缺血发作（TIA）高危患者。尚未评估经颅彩色超声（TCCS）在此情况下的预测价值。
对在症状发作后 24 小时内于 TIA 诊所接受 TIA 或小卒中治疗的患者进行了一项回顾性分析。评估 TCCS 与 MRI 三维时间飞跃成像对诊断近端（颈内动脉、椎动脉、基底动脉、Willis 环和大脑中动脉主干）＞50%狭窄或闭塞的颅内症状性动脉的一致性。计算 TCCS 对预测 7 天内复发性 TIA/卒中的敏感性、特异性、预测值和似然比。
在过去 24 小时内发生 TIA 或小卒中的 159 例患者中，142 例具有可读取的声窗（89.3%）。116 例患者中 TCCS 和 MRI 彼此相隔 4 小时内完成。MRI 在 6 例患者中显示出症状性近端颅内狭窄/闭塞病变。MRI 与 TCCS 的一致性极好（κ 系数=1）。10 例患者（8 例 TIA 和 2 例小卒中）发生了复发性 TIA/卒中。所有复发均发生在症状发作后 24 小时内。在 10 例复发患者中有 4 例（40%）和在 132 例无复发患者中有 3 例（3%）TCCS 发现有症状性近端颅内狭窄/闭塞病变[敏感性 40%；特异性 97.7%；似然比 18.1；调整 ABCD(2) 评分后的比值比（95%CI）为 31.5（4.5-218.6）]。
我们的研究表明，TCCS 可用于指导 TIA 患者的分诊。
