Abstract W P141: Cerebral Microbleeds and White Matter Hyperintensities as Predictors for Early Stroke Recurrences in Transient Ischemic Attack: Korean TIA eXpression Study

Abstract

Background: Patients within 24 hours from symptom onset of transient ischemic attack (TIA) are particularly at high risk of early recurrent stroke. Neuroimaging variables are increasingly recognized to help better identify patients at high risk. The Korean TIA eXpression study aimed to determine the risk of early recurrent stroke and its clinical and imaging predictors. Methods: We conducted a hospital-based, multi-center prospective cohort study. TIA was defined by transient focal neurological deficits which result from ischemia and last less than 24 hours. Inclusion criteria were: 1) patients who admitted within 24 hours after symptom onset, 2) those who underwent magnetic resonance imaging and angiography, and 3) age of 45 years or older. We collected baseline data of demographics, vascular risk factors, clinical manifestation, potential mechanism of TIA, neuroimaging findings of acute ischemic lesions, white matter changes, microbleeds, vascular status, and laboratory test results. The primary endpoint was recurrent stroke within 90 days. Results: A total of 500 patients (mean age 64.4, male 58%, mean ABCD2 score 4.3 ± 1.4) were enrolled and completed 90-day follow-up. The primary endpoint of recurrent stroke developed in 25 (5.0%) patients within 90 days. From univariable analyses, we identified the following potential predictors (p < 0.20) of recurrent stroke within 90 days: ABCD2 scores, crescendo TIA, lacunar TIA, symptomatic extracranial occlusion, old lacune, white matter hyperintensities, and cerebral microbleeds. In a multivariable logistic regression analysis, crescendo TIA (adjusted odds ratio (OR) 4.4, 95% confidential interval (CI) 1.3-14.7), lacunar TIA (OR 2.5, 95% CI 1.1-6.1), white matter hyperintensities (OR 2.4, 95% CI 1.1-5.4), and cerebral microbleeds (OR 4.9, 95% CI 1.9-12.8) were independently associated with recurrent stroke within 90 days. Conclusion: In conclusion, the current study suggests that microangiopathy may be a predictor for early recurrent strokes after TIA. Our novel findings need to be validated in future studies.