Early stroke risk after transient ischemic attack among individuals with symptomatic intracranial artery stenosis.
BACKGROUND
Little is known about short-term vascular risk after transient ischemic attack (TIA) caused by intracranial atherosclerosis.


OBJECTIVE
To quantify the early risk of ischemic stroke in the territory of a stenotic intracranial artery after TIA and to identify clinical and imaging features associated with increased risk of stroke in the territory among patients with TIA.


METHODS
Cohort study.


METHODS
Academic research. Patients The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) study enrolled patients having TIA or nondisabling stroke within the preceding 3 months and demonstrating corresponding 50% to 99% stenosis of a major intracranial artery on angiography.


METHODS
We calculated the cumulative risk of stroke in the territory of the symptomatic artery during the first 90 days after randomization among patients having TIA alone as a qualifying event compared with patients having stroke alone. We assessed selected factors for association with stroke among patients having TIA as the qualifying event.


RESULTS
The 90-day risk of ischemic stroke in the arterial territory was 6.9% (95% confidence interval, 4.2%-11.2%) after TIA compared with 4.7% (95% confidence interval, 2.7%-8.4%) after stroke (P =.32). Among patients having TIA alone as the qualifying event, 60.0% (15 of 25) of all strokes in the arterial territory occurred in the first 90 days compared with 34.4% (11 of 32) among patients having stroke alone as the qualifying event (P =.05). Among subjects with TIA, the presence of cerebral infarct on baseline neuroimaging was the only statistically significant predictor of higher risk of early stroke (hazard ratio, 4.7; 95% confidence interval, 1.4-15.5; P =.006).


CONCLUSIONS
Among individuals having intracranial atherosclerotic disease with TIA, most subsequent strokes in the territory of a stenotic intracranial artery occur early (ie, < or =90 days). Prompt management of TIA in patients having intracranial stenosis, particularly those demonstrating cerebral infarction on brain imaging, is indicated.
Ovbiagele
Bruce
B
Stroke Center and Department of Neurology, UCLA Medical Center, University of California at Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095, USA. Ovibes@mednet.ucla.edu
Cruz-Flores
Salvador
S
Lynn
Michael J
MJ
Chimowitz
Marc I
MI
D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000150:complications / Q000453:epidemiology; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications* / Q000453:epidemiology*; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology*; D013997:Time Factors