Ornello Raffaele, Foschi Matteo, De Santis Federico, Romoli Michele, Tassinari Tiziana, Saia Valentina, Cenciarelli Silvia, Bedetti Chiara, Padiglioni Chiara, Censori Bruno, Puglisi Valentina, Vinciguerra Luisa, Guarino Maria, Barone Valentina, Zedde Maria Luisa, Grisendi Ilaria, Diomedi Marina, Bagnato Maria Rosaria, Petruzzellis Marco, Mezzapesa Domenico Maria, Di Viesti Pietro, Inchingolo Vincenzo, Cappellari Manuel, Zenorini Mara, Candelaresi Paolo, Andreone Vincenzo, Rinaldi Giuseppe, Bavaro Alessandra, Cavallini Anna, Moraru Stefan, Querzani Pietro, Terruso Valeria, Mannino Marina, Scoditti Umberto, Pezzini Alessandro, Frisullo Giovanni, Muscia Francesco, Paciaroni Maurizio, Mosconi Maria Giulia, Zini Andrea, Leone Ruggiero, Palmieri Carmela, Cupini Letizia Maria, Marcon Michela, Tassi Rossana, Sanzaro Enzo, Paci Cristina, Viticchi Giovanna, Orsucci Daniele, Falcou Anne, Diamanti Susanna, Tarletti Roberto, Nencini Patrizia, Rota Eugenia, Sepe Federica Nicoletta, Ferrandi Delfina, Caputi Luigi, Volpi Gino, La Spada Salvatore, Beccia Mario, Rinaldi Claudia, Mastrangelo Vincenzo, Di Blasio Francesco, Invernizzi Paolo, Pelliccioni Giuseppe, De Angelis Maria Vittoria, Bonanni Laura, Ruzza Giampietro, Caggia Emanuele Alessandro, Russo Monia, Tonon Agnese, Acciarri Maria Cristina, Anticoli Sabrina, Roberti Cinzia, Manobianca Giovanni, Scaglione Gaspare, Pistoia Francesca, Fortini Alberto, De Boni Antonella, Sanna Alessandra, Chiti Alberto, Barbarini Leonardo, Masato Maela, Del Sette Massimo, Passarelli Francesco, Bongioanni Maria Roberta, Toni Danilo, Ricci Stefano, Sacco Simona, De Matteis Eleonora
Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Department of Neuroscience, Maurizio Bufalini Hospital, AUSL Romagna, Cesena, Italy.
Int J Stroke. 2025 Apr;20(4):426-437. doi: 10.1177/17474930241302691. Epub 2024 Dec 16.
According to the literature, about one third of patients with brain ischemic symptoms lasting <24 h, which are classified as Transient ischemic attacks (TIAs) according to the traditional "time-based" definition, show the presence of acute ischemic lesions at neuroimaging. Recent evidence has shown that the presence of acute ischemic lesions at neuroimaging may impact on the outcome of patients with transient ischemic symptoms treated with dual antiplatelet treatment (DAPT). This uncertainty is even more compelling in recent years as short-term DAPT has become the standard treatment for any non-cardioembolic TIA or minor ischemic stroke.
This is a pre-specified subgroup analysis from a prospective multicenter real-world study (READAPT). The analysis included patients with time-based TIA-that is, those with ischemic symptoms lasting <24 h-who started DAPT. In the whole population, we assessed the presence of acute brain ischemic lesions at neuroimaging and their association with the ABCD score. To assess the impact of acute brain ischemic lesions on 90-day prognosis, we performed a propensity score matching of patients with and without those lesions. We adopted a primary effectiveness outcome which was a composite of new stroke/TIA events and death due to vascular causes at 90 days.
We included 517 patients-324 (62.7%) male-with a median (interquartile range-IQR) age of 74 (IQR = 65-81) years; 144 patients (27.9%) had acute brain ischemic lesions at neuroimaging. The proportion of patients with brain ischemic lesions did not vary according to the ABCD score. At follow-up, 4 patients with brain ischemic lesions (2.8%) and 21 patients without lesions (5.6%) reported the primary effectiveness outcome, which was similar between the groups before ( = 0.178) and after matching ( = 0.518).
In our population, patients with transient ischemic symptoms and acute ischemic lesions at brain magnetic resonance imaging (MRI) had a risk of recurrent ischemic events similar to those without lesions. The risk of recurrent ischemic events was low in both groups.
根据文献，约三分之一有持续时间<24小时脑缺血症状的患者，按照传统的“基于时间”定义被归类为短暂性脑缺血发作（TIA），在神经影像学检查中显示存在急性缺血性病变。最近的证据表明，神经影像学检查中急性缺血性病变的存在可能会影响接受双重抗血小板治疗（DAPT）的短暂性缺血症状患者的预后。近年来，随着短期DAPT已成为任何非心源性TIA或轻度缺血性卒中的标准治疗方法，这种不确定性变得更加突出。
这是一项来自前瞻性多中心真实世界研究（READAPT）的预先指定亚组分析。该分析纳入了基于时间的TIA患者，即那些缺血症状持续<24小时且开始接受DAPT治疗的患者。在整个研究人群中，我们评估了神经影像学检查中急性脑缺血性病变的存在情况及其与ABCD评分的相关性。为了评估急性脑缺血性病变对90天预后的影响，我们对有和没有这些病变的患者进行了倾向评分匹配。我们采用的主要有效性结局是90天时新发卒中/TIA事件和血管性原因导致的死亡的复合结局。
我们纳入了517例患者，其中324例（62.7%）为男性，年龄中位数（四分位间距-IQR）为74岁（IQR = 65-81岁）；144例患者（27.9%）在神经影像学检查中有急性脑缺血性病变。有脑缺血性病变的患者比例并未根据ABCD评分而有所不同。在随访时，有脑缺血性病变的4例患者（2.8%）和无病变的21例患者（5.6%）报告了主要有效性结局，两组在匹配前（P = 0.178）和匹配后（P = 0.518）相似。
在我们的研究人群中，脑磁共振成像（MRI）有短暂性缺血症状和急性缺血性病变的患者发生复发性缺血事件的风险与无病变患者相似。两组复发性缺血事件的风险均较低。
