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Correlation of ABCD2 score with degree of internal carotid artery stenosis: an observational pilot study
Manar Khashram1, Thodur M Vasudevan2, Andre Donnell3
1Department of Vascular Endovascular and Transplant Surgery, Christchurch Hospital, Christchurch, New Zealand.
Insights
The ABCD2 score does not predict internal carotid artery stenosis in transient ischemic attack (TIA) patients. Urgent carotid imaging is recommended for all TIA patients to identify those who may benefit from rapid access carotid endarterectomy (RACE).
Area of Science:
- Vascular Neurology
- Cerebrovascular Disease
- Diagnostic Imaging
Background:
- The ABCD2 score is a validated tool for predicting stroke risk after transient ischemic attack (TIA).
- Current guidelines suggest outpatient investigation for low-risk TIA patients based on ABCD2 scores.
- The ABCD2 score does not identify patients with significant internal carotid artery (ICA) disease who could benefit from rapid access carotid endarterectomy (RACE).
Purpose of the Study:
- To determine the range of ABCD2 scores in patients experiencing carotid artery-related TIAs.
- To investigate the correlation between ABCD2 scores and the degree of ICA stenosis.
- To assess the relationship between ABCD2 scores and carotid plaque morphology.
Main Methods:
- Retrospective review of 97 patients who underwent carotid duplex ultrasound for TIA between January 2009 and May 2010.
- Data collected included ABCD2 scores (age, blood pressure, clinical features, diabetes, duration) and carotid plaque morphology.
- Patients had internal carotid artery (ICA) stenoses ranging from 50% to 100%.
Main Results:
- No significant correlation was found between ABCD2 scores and the degree of ICA stenosis (P=0.2, r=1.0).
- No significant correlation was observed between ABCD2 scores and carotid plaque morphology (P=1.0, r=0.0007).
- 57 out of 97 patients with significant ICA stenosis had an ABCD2 score of 4 or less.
Conclusions:
- The ABCD2 score is not a reliable predictor of significant ICA stenosis in patients with TIA.
- Urgent carotid artery imaging is crucial for all patients presenting with TIA.
- Early identification of significant ICA stenosis can facilitate timely intervention with RACE for eligible patients.
Background:
ABCD(2) is a validated scoring system that predicts the risk of stroke after a transient ischemic attack (TIA). International guidelines suggest that patients with a low score can be investigated on an outpatient basis. The ABCD2 score, however, cannot identify which patients have significant internal carotid artery (ICA) disease, and this group of patients could benefit from rapid access carotid endarterectomy (RACE). Studies have shown that patients with significant carotid artery disease have a higher risk of neurologic events or recurrent stroke. The aim of this study was to document the range of ABCD2 scores in patients with carotid artery-related TIA, and investigate any correlation between the ABCD2 scores and ICA stenosis.
Methods:
Patients undergoing carotid duplex ultrasound scan for TIA from January 2009 to May 2010 from two vascular units were identified from the vascular database retrospectively. Clinical notes were reviewed and outcomes measures were recorded: ABCD2 scores (age, blood pressure, clinical features, diabetes, and duration) and carotid plaque morphology.
Results:
Ninety-seven patients with a mean age of 74 (range 56-90) years had ICA stenoses of ≥50% up to 100%. Fifty-seven patients had an ABCD2 score of ≤4. There was no significant correlation between ABCD2 scores and degree of ICA stenosis nor carotid plaque morphology (P=0.2, r=1.0, and P=1.0, r=0.0007, respectively).
Conclusions:
Because no correlation between ABCD2 scores and the degree of ICA stenosis was found, all patients with carotid territory TIA should undergo urgent imaging of the carotid arteries because a high proportion of these patients may benefit from RACE.
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