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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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    Fig 1.

    A 57-year-old woman with right transient hemiparesis (clinical duration = 2 minutes, delay since the first clinical symptom = 12 hours). ABCD2 score = 4. A, DWI shows some foci of high signal intensity in the left frontal lobe with a decrease of ADC on the ADC map (B). C, 3D TOF reveals a significant proximal stenosis of the left M1 segment (arrow). The patient had another right transient impairment in the subsequent 48 hours.

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    Fig 2.

    A 59-year-old man with left regressive hemiparesis (clinical duration = 3 minutes, delay since the first clinical symptom = 3 hours). ABCD2 score = 4. A, DWI demonstrates a subtle hyperintensity in the right subinsular region with corresponding decrease of ADC on the ADC map (B). C, 3D TOF depicts right M1 segment grade 2 occlusion (arrow), responsible for the acute ischemic lesion in the insular lobe. The patient had another left transient hemiparesis in the subsequent 48 hours.

Tables

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    Table 1:

    Characteristics of patients stratified by MRA findingsa

    Intracranial Artery Stenosis/Occlusion (n = 16)No Intracranial Artery Stenosis/Occlusion (n = 113)P Value
    Age (yr) (mean) (SD)67.9 (8.9)62.9 (15.9).22
    Male8 (50.0)66 (58.4).59
    Hypertension9 (56.3)48 (42.5).42
    Cigarette smoking3 (18.8)29 (27.5)1
    Hypercholesterolemia6 (37.5)42 (37.2).97
    Previous stroke/TIA2 (12.5)15 (13.3)1
    Diabetes4 (25.0)10 (8.8).07
    ABCD2 score ≥411 (68.8)56 (49.6).18
    Extracranial carotid stenosis >50%2 (12.5)10 (8.3).64
    Atrial fibrillation1 (6.3)8 (7.1)1
    Acute infarction on DWI13 (81.2)29 (25.6)<.001
    • ↵a Values in parentheses are percentages unless otherwise indicated.

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    Table 2:

    Individual data from patients with early recurrence

    Patient No.Type of RecurrenceABCD2 ScoreAcute Infarction on DWIMRA Lesion
    1Stroke4NoNone
    2TIA4YesProximal occlusion
    3TIA3NoProximal stenosis
    4TIA4NoNone
    5TIA5YesNone
    6Stroke6NoNone
    7TIA5NoNone
    8TIA5NoNone
    9TIA4YesProximal stenosis
    • View popup
    Table 3:

    Performance of MRI variables as predictors of recurrent transient ischemic attack or stroke at 7 days among 129 patients evaluated within 24 hours of symptom onset

    Sensitivity (%) (No.)Specificity (%) (No.)Positive Predictive Value (%) (No.)Negative Predictive Value (%) (No.)Odds Ratio (95% Confidence Interval)P Value
    DWI33.3 (3/9)67.5 (81/120)7.1 (3/42)93.1 (81/87)1.03 (0.24–4.37)1
    MRA33.3 (3/9)89.2 (107/120)18.8 (3/16)94.7 (107/113)4.11 (0.91–18.4).08
    MRA proximal33.3 (3/9)93.3 (112/120)27.3 (3/11)94.9 (112/118)7.0 (1.47–33.3).03
    • Note:—DWI indicates acute infarction on DWI; MRA, distal or proximal stenosis or occlusion of symptomatic intracranial artery on MR angiography; MRA proximal, proximal stenosis or occlusion of symptomatic intracranial artery on MR angiography.

    • View popup
    Table 4:

    Characteristics of patients with early recurrencea

    Early Recurrence (n = 9)No Early Recurrence (n = 120)P Valueb
    Atrial fibrillation1 (11.1)8 (6.7)1
    Extracranial carotid stenosis >50%1 (11.1)11 (9.2)1
    ABCD2 score ≥48 (88.9)59 (49.2)0.03
    • ↵a Values in parentheses are percentages unless otherwise indicated.

    • ↵b Fisher exact test.

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American Journal of Neuroradiology: 34 (1)
American Journal of Neuroradiology
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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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