Implicaciones diagnósticas del perfil de recurrencia tras un ataque isquémico transitorio

Abstract

Background and objective Early stroke recurrence risk alter a transient ischemic attack (TIA) is high. We studied the diagnostic implications of the recurrence pattern after TIA. Methods 210 consecutive TIA patients were studied. Ultrasonographic (US), neuroimaging and cardiologic data were collected. Results At 90 day follow-up, 14 patients (6.7%; 95% CI: 3.3–10.1) among 209 suffered an ischemic infarction (II), 9 (4.3%; 1.5–7.1) a TIA and 6 (2.9%; 0.6–5.1) a cardiac ischemic event. Moreover, 13 patients (6.2%; 2.8–9.6) among 210 with a seven-day follow-up had an II. Multivariate analyses only identified the presence of intracranial stenoses (HR, 23.29; 95% CI, 3.49 to 23.57; p<0.018) as independent predictors of stroke within the first 7 days, and large-artery occlusive disease (HR, 9.07; CI, 3.49 to 23.57; p<0.001) as a predictor of stroke recurrence at 90 day follow-up. A new diagnosis of atrial fibrillation was observed in 21 subjects (10.0%), and it was documented in the baseline ECG in 62% cases. Acute diffusion abnormalities were identified in 81 (44,5%) of 182 patients, and chronic ischemic lesions were observed in 110 (60.4%) on MRI vs 56 (26.7%) among 210 on CT scan. Conclusion Due to very early recurrence, the routine use of ultrasonography within the first hours after an index TIA will be useful to identify those patients at high risk. The prognostic usefulness of diffusion-weighted studies will be only achieved if it is performed early. Routine noninvasive cardiac rhythm monitoring has a low detection rate.