Department of Neurology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea.
JAMA Neurol. 2015 Mar;72(3):301-8. doi: 10.1001/jamaneurol.2014.3958.
The risk of early recurrent stroke after transient ischemic attack (TIA) may be modifiable by optimal treatment. Although ABCD2 scores, diffusion-weighted imaging lesions, and large artery stenosis are well known to predict early stroke recurrence, other neuroimaging parameters, such as cerebral microbleeds (CMBs), have not been well explored in patients with TIA.
To determine the rate of early recurrent stroke after TIA and its neuroimaging predictors.
DESIGN, SETTING, AND PARTICIPANTS: In this hospital-based, multicenter prospective cohort study, consecutive patients with TIA were enrolled from 11 university hospitals from July 1, 2010, through December 31, 2012. Patients who were admitted within 24 hours after symptom onset and underwent diffusion-weighted imaging were included.
The primary end point was recurrent stroke within 90 days. Baseline demographics, clinical manifestations, neuroimaging findings, and use of antithrombotics or statins also were analyzed.
A total of 500 patients (mean age, 64 years; male, 291 [58.2%]; median ABCD2 score, 4) completed 90-day follow-up with guideline-based management: antiplatelets (457 [91.4%]), anticoagulants (74 [14.8%]), and statins (345 [69.0%]). Recurrent stroke occurred in 25 patients (5.0%). Compared with patients without recurrent stroke, those with recurrent stroke were more likely to have crescendo TIA (20 [4.2%] vs 4 [16.0%], P = .03), white matter hyperintensities (146 [30.7%] vs 13 [52.0%], P = .03), and CMBs (36 [7.6%] vs 7 [28.0%], P = .003). On multivariable Cox proportional hazards analysis, CMBs remained as independent predictors for recurrent stroke (hazard ratio, 3.66; 95% CI, 1.47-9.09; P = .005).
Immediate and optimal management seems to modify the risk of recurrent stroke after TIA. Cerebral microbleeds may be novel predictors of stroke recurrence, which needs further validation.
短暂性脑缺血发作（TIA）后早期复发卒中的风险可能可以通过最佳治疗来改变。尽管 ABCD2 评分、弥散加权成像病变和大动脉狭窄是众所周知的预测早期卒中复发的因素，但 TIA 患者的其他神经影像学参数，如脑微出血（CMB），尚未得到充分探讨。
确定 TIA 后早期复发卒中的发生率及其神经影像学预测因素。
设计、地点和参与者：在这项基于医院的、多中心前瞻性队列研究中，连续纳入 2010 年 7 月 1 日至 2012 年 12 月 31 日期间从 11 所大学医院入院的 TIA 患者。纳入标准为症状发作后 24 小时内入院并接受弥散加权成像的患者。
主要终点是 90 天内复发卒中。还分析了基线人口统计学、临床表现、神经影像学发现以及抗血栓药物或他汀类药物的使用情况。
共有 500 例患者（平均年龄 64 岁；男性 291 例[58.2%]；中位 ABCD2 评分 4 分）完成了 90 天的基于指南的管理随访：抗血小板治疗（457 例[91.4%]）、抗凝治疗（74 例[14.8%]）和他汀类药物治疗（345 例[69.0%]）。25 例患者（5.0%）发生了复发性卒中。与无复发性卒中的患者相比，复发性卒中患者更有可能出现进展性 TIA（20 例[4.2%] vs 4 例[16.0%]，P = .03）、脑白质高信号（146 例[30.7%] vs 13 例[52.0%]，P = .03）和 CMB（36 例[7.6%] vs 7 例[28.0%]，P = .003）。多变量 Cox 比例风险分析显示，CMB 仍然是复发性卒中的独立预测因素（风险比，3.66；95%CI，1.47-9.09；P = .005）。
急性和最佳治疗似乎可以改变 TIA 后复发性卒中的风险。脑微出血可能是卒中复发的新预测因素，尚需进一步验证。
