Prognostic value of "tissue-based" definitions of TIA and minor stroke: Population-based study.

Abstract

OBJECTIVE:

Since use of diffusion-weighted imaging (DWI) positivity in the "tissue-based" definition of stroke in patients with a clinical TIA is supported by the high associated 90-day risk of recurrent stroke, we aimed to determine long-term prognostic significance, stratified by etiologic subtype, and whether the same tissue-based distinction is predictive in minor strokes.

METHODS:

Consecutive eligible patients with TIA or minor stroke (NIH Stroke Scale [NIHSS] ≤3) in the population-based Oxford Vascular Study underwent brain MRI at baseline. Stroke risk on 10-year follow-up was stratified by NIHSS (0/1 vs 2/3) and Trial of Org 10172 in Acute Stroke Treatment classification of the initial event.

RESULTS:

Among 1,033 patients (633 TIA; 400 minor stroke), 248 (24.0%) had acute lesions on DWI (13.9% of TIAs; 40.0% of minor strokes). A positive DWI was associated with an increased 10-year risk of recurrent ischemic stroke after an index TIA (hazard ratio [HR] 2.66, 95% confidence interval [CI] 1.28-5.54, p = 0.009) or a stroke with NIHSS 0-1 (3.03, 1.29-7.08, p = 0.011), but not after a stroke with NIHSS 2-3 (0.70, 0.24-2.10, p = 0.53). Ischemic stroke risk after DWI-positive TIA was at least equivalent to that after DWI-negative stroke (1.81, 0.82-4.00, p = 0.14). Among all patients, DWI positivity was most predictive of 10-year risk after cryptogenic events (4.68, 1.70-12.92, p = 0.003).

CONCLUSION:

DWI positivity is associated with an increased long-term risk of recurrent stroke after TIA and minor stroke, supporting a tissue-based definition of minor stroke as well as TIA. Prognostic value is greatest after cryptogenic events.

• Authors: Robert Hurford, Linxin Li, Nicola Lovett, Magdalena Kubiak, Wilhelm Kuker, Peter M Rothwell, Oxford Vascular Study
• Journal: Neurology (Neurology) Vol. 92 Issue 21 Pg. e2455-e2461 (05 21 2019) ISSN: 1526-632X [Electronic] United States
• PMID: 30996061 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

Topics

• Aged
• Aged, 80 and over
• Brain (diagnostic imaging)
• Diffusion Magnetic Resonance Imaging
• Female
• Humans
• Ischemic Attack, Transient (diagnostic imaging)
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Prognosis
• Proportional Hazards Models
• Recurrence
• Severity of Illness Index
• Stroke (diagnostic imaging)