'Crescendo' transient ischemic attacks: clinical and angiographic correlations.

Area of Science:

• Vascular Neurology
• Cerebrovascular Disease
• Interventional Neurology

Background:

• Transient ischemic attacks (TIAs) are critical warning signs of impending stroke.
• Anterior circulation TIAs, particularly "crescendo" TIAs, suggest significant internal carotid artery (ICA) pathology.
• Predicting the presence and severity of ICA disease based on clinical presentation is crucial for timely intervention.

Purpose of the Study:

• To identify clinical features that reliably predict significant stenosis, ulceration, or both in the symptomatic internal carotid artery.
• To correlate specific TIA symptom patterns with angiographic findings in patients with anterior circulation ischemia.

Main Methods:

• Prospective evaluation of 47 consecutive patients presenting with crescendo TIAs.
• Clinical assessment of symptoms including cortical ischemia, amaurosis fugax, numbness, and weakness.
• Correlation of clinical findings with angiographic or intraoperative confirmation of internal carotid artery disease.

Main Results:

• Twenty-six patients (55%) had anatomically significant internal carotid artery disease.
• Patients with cortical ischemia or amaurosis fugax had a high rate of positive angiograms (17/20, 85%).
• Patients with only numbness/weakness had a lower rate of positive angiograms (9/18, 50%), and those with lacunar symptoms had none.

Conclusions:

• Clinical presentation, particularly cortical symptoms and transient monocular blindness (amaurosis fugax), is a strong predictor of significant internal carotid artery disease in crescendo TIA patients.
• Prompt investigation and intervention are warranted for patients exhibiting these high-risk clinical features to prevent stroke.