Intracranial artery stenosis or occlusion predicts ischemic recurrence after transient ischemic attack.
OBJECTIVE
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.


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 ABCD(2) 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 ABCD(2) 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.
Department of Neuroradiology, University of Toulouse, Toulouse. France.
G
G
Ssi-Yan-Kai
N
N
Nasr
A
A
Faury
I
I
Catalaa
C
C
Cognard
V
V
Larrue
F
F
Bonneville
D000368:Aged; D015897:Comorbidity; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D020765:Intracranial Arterial Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000453:epidemiology*; D018810:Magnetic Resonance Angiography / Q000706:statistics & numerical data*; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors