Transient ischaemic attack: is routine use of computerised cerebral tomography worthwhile?

To evaluate the role of routine computerised cerebral tomography (CCT) in patients undergoing carotid endarterectomy (CEA) following transient ischaemic attach (TIA).

A retrospective review was carried out of data collected on patients with TIA who were managed at the Durban Metropolitan Vascular Service over an 11-year period. All patients underwent carotid duplex scanning and CCT, followed by carotid endarterectomy (CEA) under general anaesthesia.

The records of 140 patients were reviewed. There were 85 (61%) men and 55 (39%) women (F:M = 1:1.6). The mean age was 63 years (range 40-95 years). The presenting symptoms were amaurosis fugax, syncope and speech deficit. Risk factors for arterial disease were smoking (73%), hypertension (55%), diabetes mellitus (28%) and hyperlipidaemia (6%). Duplex ultrasonography showed significant internal carotid artery stenosis in 138 patients and occlusion in two. Arch angiography of the latter two patients showed pre-occlusive carotid stenosis. CCT scans showed abnormalities in 34 (24%) patients. These were lacunar infarcts (56%), old infarcts involving grey and white matter (32%), and cortical infarcts (12%). The findings did not influence management. All patients underwent routine CEA with selective shunting in 51 (36%) patients. Postoperative stroke rate was 2.9%.

Routine CCT scanning in patients with TIA did not influence patient management and outcome. It is not cost effective and its routine use is questioned.