Short- and Long-Term Prognoses After Tissue-Negative Transient Ischemic Attack
Francisco Purroy1,2, Yhovany Gallego1,2, M Pilar Gil-Villar1,2
1Department of Neurology (F.P., Y.G., M.P.G.-V., A.Q., J.S., D.V.-J., G.M.), Stroke Unit, Hospital Universitari Arnau de Vilanova de Lleida, Spain.
Stroke
|December 5, 2024
Summary
Patients with negative diffusion-weighted imaging (DWI) transient ischemic attacks (TIA) face significant stroke recurrence risk. Optimized secondary prevention is crucial, as early and late stroke predictors differ.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Medical Imaging
Background:
- The clinical definition of transient ischemic attack (TIA) using diffusion-weighted imaging (DWI) has practical limitations.
- Limited evidence exists on stroke risk and predictors in DWI-negative TIA patients.
- This study addresses the prognosis of DWI-negative TIA patients presenting to emergency departments.
Purpose of the Study:
- To evaluate the early and long-term prognosis of patients with DWI-negative TIAs.
- To identify predictors of stroke recurrence in this patient group.
- To inform secondary prevention strategies for DWI-negative TIA patients.
Main Methods:
- Prospective cohort study of neurologist-confirmed, DWI-negative TIA patients.
- DWI performed within 4 days of the index event.
- Stroke recurrence (SR) assessed at 1 year and long-term (median 6.6 years).
Main Results:
- 370 patients included; 15 (4.1%) experienced 1-year SR, 18 (4.9%) experienced SR beyond 1 year.
- Large artery atherosclerosis predicted 1-year SR.
- Male sex, speech impairment, and chronic microangiopathy (Fazekas score 3) predicted long-term SR.
Conclusions:
- DWI-negative TIA patients have a significant risk of recurrent vascular events.
- Optimized secondary prevention is warranted for these patients.
- Stroke recurrence predictors vary between early and long-term follow-up periods.
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