title: Transcranial color-coded sonography to predict recurrent transient ischaemic attack/stroke.
abstract: OBJECTIVE
  Patients with transient ischaemic attack (TIA) with a high risk of imminent stroke can be identified with the ABCD(2) score and findings on MRI and CT angiography. The predictive value of transcranial color-coded sonography (TCCS) has not been evaluated in this setting.
  
  
  METHODS
  A retrospective analysis was conducted of patients consecutively treated for TIA or minor stroke in a TIA clinic within 24 h of symptom onset. Agreement between TCCS and MRI three-dimensional time-of-flight images for the diagnosis of proximal (internal carotid artery, vertebral artery, basilar artery, circle of Willis and main stem of the middle cerebral artery) >50% stenosis or occlusion of the intracranial symptomatic artery was evaluated. The sensitivity, specificity, predictive values and likelihood ratio of TCCS for predicting recurrent TIA/stroke at 7 days were calculated.
  
  
  RESULTS
  Of 159 patients with a TIA or minor stroke within the last 24 h, 142 had a readable acoustic temporal bone window (89.3%). TCCS and MRI were performed within 4 h of each other in 116 patients. MRI showed a symptomatic proximal intracranial steno-occlusive lesion in six patients. Agreement between MRI and TCCS was perfect (κ coefficient = 1). Recurrent TIA/stroke occurred in 10 patients (eight TIA and two minor strokes). All recurrences occurred within 24 h of symptom onset. A symptomatic proximal intracranial steno-occlusive lesion was found on TCCS in 4/10 patients with recurrence and 3/132 patients without recurrence [sensitivity 40%; specificity 97.7%; likelihood ratio 18.1; odds ratio (95% CI) adjusted for ABCD(2) score 31.5 (4.5-218.6)].
  
  
  CONCLUSIONS
  Our study shows that TCCS can be used to guide triage of patients with TIA.
authors: Department of Vascular Neurology, UMR U1048, University of Toulouse, Toulouse, France. nathalie.nasr@orange.fr
authors: N
authors: N
authors: Nasr
authors: G
authors: G
authors: Ssi-Yan-Kai
authors: B
authors: B
authors: Guidolin
authors: F
authors: F
authors: Bonneville
authors: V
authors: V
authors: Larrue
mesh_terms: D002545:Brain Ischemia / Q000000981:diagnostic imaging*; D002539:Cerebral Arterial Diseases / Q000000981:diagnostic imaging; D002536:Cerebral Arteries / Q000000981:diagnostic imaging; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging*; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*
keywords: arterial occlusion; arterial stenosis; cerebral circulation; magnetic resonance imaging; stroke; transcranial color-coded sonography; transient ischaemic attack; ultrasound/Doppler