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Research ArticleExtracranial Vascular

Intracranial Artery Stenosis or Occlusion Predicts Ischemic Recurrence after Transient Ischemic Attack

G. Ssi-Yan-Kai, N. Nasr, A. Faury, I. Catalaa, C. Cognard, V. Larrue and F. Bonneville
American Journal of Neuroradiology January 2013, 34 (1) 185-190; DOI: https://doi.org/10.3174/ajnr.A3144
G. Ssi-Yan-Kai
aFrom the Departments of Neuroradiology (G.S.-Y.-K., A.F., I.C., C.C., F.B.)
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N. Nasr
bVascular Neurology (N.N., V.L.)
cUnité médicale de recherche U1048, Institut national de santé et de recherche médicale (N.N., V.L.)
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A. Faury
aFrom the Departments of Neuroradiology (G.S.-Y.-K., A.F., I.C., C.C., F.B.)
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I. Catalaa
aFrom the Departments of Neuroradiology (G.S.-Y.-K., A.F., I.C., C.C., F.B.)
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C. Cognard
aFrom the Departments of Neuroradiology (G.S.-Y.-K., A.F., I.C., C.C., F.B.)
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V. Larrue
bVascular Neurology (N.N., V.L.)
cUnité médicale de recherche U1048, Institut national de santé et de recherche médicale (N.N., V.L.)
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F. Bonneville
aFrom the Departments of Neuroradiology (G.S.-Y.-K., A.F., I.C., C.C., F.B.)
dUnité médicale de recherche U825, Institut national de santé et de recherche médicale (F.B.), University of Toulouse, Toulouse. France.
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Abstract

BACKGROUND AND PURPOSE: Patterns of DWI findings that predict recurrent ischemic events after TIA are well-established, but similar assessments of intracranial MRA findings are not available. We sought to determine the imaging characteristics of MRA that are predictive of early recurrent stroke/TIA in patients with TIA.

MATERIALS AND METHODS: We performed a retrospective analysis of 129 consecutive patients with a clinical diagnosis of TIA in whom MR imaging was done within 24 hours of symptom onset. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of >50% stenosis or occlusion of symptomatic intracranial arteries for recurrent stroke/TIA at 7 days after TIA. We used logistic regression analysis to adjust for the clinical ABCD2 score. We performed this analysis for symptomatic steno-occlusive lesions at any site and symptomatic steno-occlusive lesions on proximal large intracranial arteries (internal carotid artery, vertebral artery, basilar artery, and circle of Willis).

RESULTS: Forty-two (32.5%) patients had acute ischemic lesions on DWI; 16 (12.4%) had significant MRA lesions, of which 11 (8.5%) were on proximal vessels. Nine patients had early recurrence (TIA, 7; minor stroke, 2). Only patients with proximal MRA lesions were at higher risk of early recurrence independent of the ABCD2 score (adjusted odds ratio, 5.5; 95% confidence interval, 1.1–27.8; P = .04).

CONCLUSIONS: Proximal lesions of cerebral arteries seen on MRA were predictive of recurrent stroke/TIA at 7 days. These findings suggest that MRA could be used to improve the selection of patients with TIA at high risk of early recurrent stroke/TIA.

ABBREVIATIONS:

ABCD2
age, blood pressure, clinical deficit, duration, diabetes
EKG
electrocardiogram
MIP
maximum intensity projection
TOF
time of flight
  • © 2013 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 34 (1)
American Journal of Neuroradiology
Vol. 34, Issue 1
1 Jan 2013
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Intracranial Artery Stenosis or Occlusion Predicts Ischemic Recurrence after Transient Ischemic Attack
G. Ssi-Yan-Kai, N. Nasr, A. Faury, I. Catalaa, C. Cognard, V. Larrue, F. Bonneville
American Journal of Neuroradiology Jan 2013, 34 (1) 185-190; DOI: 10.3174/ajnr.A3144

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Intracranial Artery Stenosis or Occlusion Predicts Ischemic Recurrence after Transient Ischemic Attack
G. Ssi-Yan-Kai, N. Nasr, A. Faury, I. Catalaa, C. Cognard, V. Larrue, F. Bonneville
American Journal of Neuroradiology Jan 2013, 34 (1) 185-190; DOI: 10.3174/ajnr.A3144
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