Altenbernd Jens-Christian, Gramada Razvan, Kessler Eugen, Skatulla Jakob, Geppert Eduard, Eyding Jens, Nordmeyer Hannes
Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany.
Department of Radiology and Neuroradiology, Gemeinschaftskrankenhaus Herdecke, 58313 Herdecke, Germany.
J Clin Med. 2022 Sep 26;11(19):5686. doi: 10.3390/jcm11195686.
Transient ischemic attacks (TIAs) and minor strokes are often precursors of a major stroke. Therefore, diagnostic work-up of the TIA is essential to reduce the patient's risk of further ischemic events.
With the help of this retrospective study, we aim to determine for which TIA patients a CT angiography (CTA) is not immediately necessary in order to reduce radiation exposure and nephrotoxicity.
Clinical and imaging data from patients who presented as an emergency case with a suspected diagnosis of TIA at a teaching hospital between January 2016 and December 2021 were evaluated. The included 1526 patients were divided into two groups-group 1, with major pathologic vascular findings in the CTA, and group 2, with minor vascular pathologies.
Out of 1821 patients with suspected TIA on admission, 1526 met the inclusion criteria. In total, 336 (22%) had major vascular pathologies on CTA, and 1190 (78%) were unremarkable. The majority of patients with major vascular pathologies were male and had a history of arterial hypertension, coronary heart disease, myocardial infarction, ischemic stroke, TIA, atherosclerotic peripheral vascular disease, smoking, antiplatelet medication, had a lower duration of TIA symptoms, and had lower ABCD2 scores.
We were able to demonstrate a direct correlation between major CTA pathologies and a history of smoking, age, hyperlipidemia, history of peripheral arterial disease, and a history of stroke and TIA. We were able to prove that the ABCD2 score is even reciprocal to CTA pathology. This means that TIA patients without described risk factors do not immediately require a CTA and could be clarified in the course of treatment with ultrasound or MRI.
短暂性脑缺血发作（TIA）和轻度中风通常是重大中风的先兆。因此，对TIA进行诊断性检查对于降低患者发生进一步缺血性事件的风险至关重要。
通过这项回顾性研究，我们旨在确定哪些TIA患者无需立即进行CT血管造影（CTA），以减少辐射暴露和肾毒性。
对2016年1月至2021年12月期间在一家教学医院因疑似TIA作为急诊病例就诊的患者的临床和影像数据进行评估。纳入的1526例患者分为两组——第1组，CTA有重大病理性血管发现；第2组，有轻微血管病变。
入院时疑似TIA的1821例患者中，1526例符合纳入标准。总共有336例（22%）CTA显示有重大血管病变，1190例（78%）无异常。大多数有重大血管病变的患者为男性，有动脉高血压、冠心病、心肌梗死、缺血性中风、TIA、动脉粥样硬化性外周血管疾病病史，吸烟，服用抗血小板药物，TIA症状持续时间较短，且ABCD2评分较低。
我们能够证明CTA重大病变与吸烟史、年龄、高脂血症、外周动脉疾病史以及中风和TIA病史之间存在直接关联。我们能够证明ABCD2评分与CTA病变呈反比。这意味着无所述危险因素的TIA患者无需立即进行CTA检查，可在治疗过程中通过超声或MRI进行明确诊断。
