Transcranial color-coded sonography to predict recurrent transient ischaemic attack/stroke.

Abstract

BACKGROUND AND PURPOSE:

Patients with transient ischaemic attack (TIA) with a high risk of imminent stroke can be identified with the ABCD(2) score and findings on MRI and CT angiography. The predictive value of transcranial color-coded sonography (TCCS) has not been evaluated in this setting.

METHODS:

A retrospective analysis was conducted of patients consecutively treated for TIA or minor stroke in a TIA clinic within 24 h of symptom onset. Agreement between TCCS and MRI three-dimensional time-of-flight images for the diagnosis of proximal (internal carotid artery, vertebral artery, basilar artery, circle of Willis and main stem of the middle cerebral artery) >50% stenosis or occlusion of the intracranial symptomatic artery was evaluated. The sensitivity, specificity, predictive values and likelihood ratio of TCCS for predicting recurrent TIA/stroke at 7 days were calculated.

RESULTS:

Of 159 patients with a TIA or minor stroke within the last 24 h, 142 had a readable acoustic temporal bone window (89.3%). TCCS and MRI were performed within 4 h of each other in 116 patients. MRI showed a symptomatic proximal intracranial steno-occlusive lesion in six patients. Agreement between MRI and TCCS was perfect (κ coefficient = 1). Recurrent TIA/stroke occurred in 10 patients (eight TIA and two minor strokes). All recurrences occurred within 24 h of symptom onset. A symptomatic proximal intracranial steno-occlusive lesion was found on TCCS in 4/10 patients with recurrence and 3/132 patients without recurrence [sensitivity 40%; specificity 97.7%; likelihood ratio 18.1; odds ratio (95% CI) adjusted for ABCD(2) score 31.5 (4.5-218.6)].

CONCLUSION:

Our study shows that TCCS can be used to guide triage of patients with TIA.

• Authors: N Nasr, G Ssi-Yan-Kai, B Guidolin, F Bonneville, V Larrue
• Journal: European journal of neurology (Eur J Neurol) Vol. 20 Issue 8 Pg. 1212-7 (Aug 2013) ISSN: 1468-1331 [Electronic] England
• PMID: 23647532 (Publication Type: Journal Article)
• Copyright: © 2013 The Author(s) European Journal of Neurology © 2013 EFNS.

Topics

• Brain Ischemia (diagnostic imaging)
• Cerebral Arterial Diseases (diagnostic imaging)
• Cerebral Arteries (diagnostic imaging)
• Data Interpretation, Statistical
• Female
• Humans
• Image Processing, Computer-Assisted
• Ischemic Attack, Transient (diagnostic imaging)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Predictive Value of Tests
• Recurrence
• Retrospective Studies
• Stroke (diagnostic imaging)
• Ultrasonography, Doppler, Color (methods)
• Ultrasonography, Doppler, Transcranial (methods)