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When Can an Emergency CTA Be Dispensed with for TIA Patients?
Jens-Christian Altenbernd1,2, Razvan Gramada2, Eugen Kessler2
1Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany.
Insights
Transient ischemic attacks (TIAs) and minor strokes require prompt evaluation. This study found that TIAs with certain risk factors necessitate CT angiography (CTA), while others can be assessed with ultrasound or MRI, reducing unnecessary procedures.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Transient ischemic attacks (TIAs) and minor strokes are critical warning signs for subsequent major strokes.
- Effective diagnostic work-up for TIAs is crucial for mitigating the risk of further ischemic events.
Purpose of the Study:
- To identify patients with TIAs who do not require immediate CT angiography (CTA).
- To reduce radiation exposure and potential nephrotoxicity associated with unnecessary CTA scans.
Main Methods:
- Retrospective analysis of clinical and imaging data from 1526 patients with suspected TIAs.
- Patients were categorized into two groups based on CTA findings: major or minor vascular pathologies.
Main Results:
- 22% of patients (336) exhibited major vascular pathologies on CTA.
- Major pathologies correlated with male gender, hypertension, coronary heart disease, prior stroke/TIA, peripheral vascular disease, smoking, and antiplatelet use.
- Lower ABCD2 scores were associated with unremarkable CTA findings.
Conclusions:
- A direct correlation exists between major CTA pathologies and risk factors including smoking, age, hyperlipidemia, peripheral arterial disease, and history of stroke/TIA.
- The ABCD2 score is inversely related to CTA pathology, indicating its utility in risk stratification.
- TIAs in patients lacking these specific risk factors may not require immediate CTA and can be evaluated using ultrasound or MRI.
Background:
Transient ischemic attacks (TIAs) and minor strokes are often precursors of a major stroke. Therefore, diagnostic work-up of the TIA is essential to reduce the patient's risk of further ischemic events.
Purpose:
With the help of this retrospective study, we aim to determine for which TIA patients a CT angiography (CTA) is not immediately necessary in order to reduce radiation exposure and nephrotoxicity.
Material And Methods:
Clinical and imaging data from patients who presented as an emergency case with a suspected diagnosis of TIA at a teaching hospital between January 2016 and December 2021 were evaluated. The included 1526 patients were divided into two groups-group 1, with major pathologic vascular findings in the CTA, and group 2, with minor vascular pathologies.
Results:
Out of 1821 patients with suspected TIA on admission, 1526 met the inclusion criteria. In total, 336 (22%) had major vascular pathologies on CTA, and 1190 (78%) were unremarkable. The majority of patients with major vascular pathologies were male and had a history of arterial hypertension, coronary heart disease, myocardial infarction, ischemic stroke, TIA, atherosclerotic peripheral vascular disease, smoking, antiplatelet medication, had a lower duration of TIA symptoms, and had lower ABCD2 scores.
Conclusions:
We were able to demonstrate a direct correlation between major CTA pathologies and a history of smoking, age, hyperlipidemia, history of peripheral arterial disease, and a history of stroke and TIA. We were able to prove that the ABCD2 score is even reciprocal to CTA pathology. This means that TIA patients without described risk factors do not immediately require a CTA and could be clarified in the course of treatment with ultrasound or MRI.
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