Imaging Parameters Predict Recurrence After Transient Ischemic Attack or Minor Stroke Stratified by ABCD² Score

Area of Science:

• Neurology
• Radiology
• Cardiovascular Medicine

Background:

• Predicting stroke recurrence in minor ischemic stroke (MIS) and transient ischemic attack (TIA) patients using imaging is unclear, especially when stratified by traditional scores like ABCD².
• Traditional scores may not fully capture risk in all patient groups.

Purpose of the Study:

• To evaluate if imaging parameters independently predict 1-year stroke recurrence in TIA or MIS patients.
• To assess this association across different risk strata defined by the ABCD² score.

Main Methods:

• Included 7140 TIA/MIS patients (NIHSS ≤3) with baseline brain and vessel imaging.
• Stratified patients into low (0-3), moderate (4-5), and high (6-7) risk groups using the ABCD² score.
• Used multivariable Cox regression to analyze associations between large artery stenosis, infarction number, and 1-year stroke recurrence.

Main Results:

• 584 patients (8.2%) experienced recurrence within 1 year.
• Large artery stenosis independently predicted recurrence in low-risk (aHR 1.746) and moderate-risk (aHR 1.326) groups, but not high-risk.
• Infarction number also predicted recurrence in low- and moderate-risk groups, but not high-risk.

Conclusions:

• Large artery stenosis and infarction number are independent predictors of 1-year stroke recurrence in low-to-moderate risk TIA/MIS patients.
• These imaging parameters do not independently predict recurrence in high-risk TIA/MIS patients.
• Early brain and vascular imaging are crucial for accurate risk stratification in TIA/MIS patients.