[Usefulness of urgent combined carotid/transcranial ultrasound testing in early prognosis of TIA patients].
OBJECTIVE
Although patients with ischemic attacks (TIA) experience cardiovascular events frequently within the first 90 days after symptoms onset, strong clinical predictors of early recurrence are lacking. We investigate the value of combined carotid/transcranial ultrasound testing (UST) on the prognosis of TIA patients.


METHODS
UST was performed < 24 h after symptoms onset among 311 consecutive TIA patients. Stroke recurrence, myocardial infarction, or any vascular event was recorded at 7 and 90 days of follow-up.


RESULTS
A total of 20 patients suffered an stroke within 7 days of symptoms onset. During the next 90 days after index TIA, 58 (18.6%) patients experienced an endpoint: 51 cerebral ischemic events, one peripheral arterial disease, 5 myocardial infarctions and one cerebellum hemorrhage. Cox proportional hazards multivariate analyses identified the presence of intracranial stenoses (HR = 3.05; 95% CI, 1.21-7.70; p = 0.018) and carotid territory implication (HR = 15.91; 95% CI, 2.11-120.04; p = 0.007) as independent predictors of stroke within the first 7 days after index TIA. Moreover, at 90 days of follow-up, large-artery occlusive disease was an independent predictor of stroke (HR = 3.07; 95% CI, 1.76-5.38; p < 0.001).


CONCLUSIONS
TIA patients with moderate to severe intracranial or extracranial stenoses have a higher risk of stroke recurrence. The routine use of UST within the first 24 h after index TIA can be useful for identifying those patients at high risk in order to plan aggressive prevention therapies.
Purroy
Francisco
F
Unidad Neurovascular, Servicio de Neurología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España. 34271fpg@comb.es
Montaner
Joan
J
Delgado
Pilar
P
Arenillas
Juan Francisco
JF
Molina
Carlos Alberto
CA
Santamarina
Esteban
E
Quintana
Manolo
M
Alvarez-Sabín
José
J
D001921:Brain / Q000098:blood supply*; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D002531:Cerebellum / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000473:pathology; D042241:Early Diagnosis; D004562:Electrocardiography; D004632:Emergency Medical Services; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging* / Q000453:epidemiology; D009203:Myocardial Infarction / Q000453:epidemiology; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*