Rapid diagnosis and treatment of TIA results in low rates of stroke, myocardial infarction and vascular death

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• 作者：D. Cocho^a ; ^{lolacocho@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; J. Monell^b ; G. Planells^c ; A.C. Ricciardi^a ; J. Pons^a ; A. Boltes^a ; J. Espinosa^a ; M. Ayats^b ; N. Garcia^c ; P. Otermin^a
• 关键词：Stroke ; Transient ischaemic attack ; Echocardiography
• 刊名：Neurología (English Edition)
• 出版年：2016
• 出版时间：January-February 2016
• 年：2016
• 卷：31
• 期：1
• 页码：18-23
• 全文大小：511 K

文摘

The 90-day risk of cerebral infarction in patients with transient ischaemic attack (TIA) is estimated at between 8% and 20%. There is little consensus as to which diagnostic strategy is most effective. This study evaluates the benefits of early transthoracic echocardiography (TTE) with carotid and transcranial Doppler ultrasound in patients with TIA.

Methods

Prospective study of patients with TIA in an emergency department setting. Demographic data, vascular risk factors, and ABCD² score were analysed. TIA aetiology was classified according to TOAST criteria. All patients underwent early vascular studies (< 72 hours), including TTE, carotid ultrasound, and transcranial Doppler. Primary endpoints were recurrence of stroke or TIA, myocardial infarction (MI), or vascular death during the first year.

Results

We evaluated 92 patients enrolled over 24 months. Mean age was 68.3 ± 13 years and 61% were male. The mean ABCD² score was 3 points (≥5 in 30%). The distribution of TIA subtypes was as follows: 12% large-artery atherosclerosis; 30% cardioembolism; 10% small-vessel occlusion; 40% undetermined cause; and 8% rare causes. Findings from the early TTE led to a change in treatment strategy in 6 patients (6.5%) who displayed normal physical examination and ECG findings. At one year of follow-up, 3 patients had experienced stroke (3.2%) and 1 patient experienced MI (1%); no vascular deaths were identified.

Conclusions

In our TIA patients, early vascular study and detecting patients with silent cardiomyopathy may have contributed to the low rate of vascular disease recurrence.