Original Article| Volume 23, ISSUE 6, P1368-1373, July 2014

Prediction of Ischemic Stroke in Patients with Tissue-Defined Transient Ischemic Attack


      The risk of future stroke after transient ischemic attack (TIA) has been widely studied, but most findings were obtained for classically defined TIA (time-defined TIA). A new definition of TIA, that is, tissue-defined TIA, which requires the absence of fresh brain infarction on magnetic resonance imaging, could change stroke risk assessments. We, therefore, aimed to evaluate the risk of future stroke in patients with tissue-defined TIA.


      We retrospectively reviewed 74 patients with tissue-defined TIA, who could be followed for 2 years. Clinical, laboratory, and radiological data were collected and compared between groups that did and did not develop ischemic stroke within the 2-year period.


      Ischemic stroke occurred in 11 patients (14.9%). Increased age, hemiparesis, and/or dysarthria during the TIA, old cerebral infarction revealed by magnetic resonance imaging, and large-artery stenosis detected by magnetic resonance angiography and/or ultrasonography tended to increase the risk of future stroke, but no individual factor showed statistically significant effect. TIA etiology did not significantly affect the risk. ABCD2 score, an established score for predicting stroke after time-defined TIA, showed only a weak association with future stroke. In contrast, new scores that we created reliably predicted future stroke; these included the APO (age, paresis, and old cerebral infarction) and APOL (age, paresis, old cerebral infarction, and large-artery stenosis) scores. The areas under the receiver operating characteristic curves were .662, .737, and .807 for ABCD2, APO, and APOL, respectively.


      Compared with the established measures, our newly created scores could predict future stroke for tissue-defined TIA more reliably.

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        • Johnston S.C.
        • Gress D.R.
        • Browner W.S.
        • et al.
        Short-term prognosis after emergency department diagnosis of TIA.
        JAMA. 2000; 284: 2901-2906
        • Hill M.D.
        • Yiannakoulias N.
        • Jeerakathil T.
        • et al.
        The high risk of stroke immediately after transient ischemic attack: a population-based study.
        Neurology. 2004; 62: 2015-2020
        • Easton J.D.
        • Saver J.L.
        • Albers G.W.
        • et al.
        Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists.
        Stroke. 2009; 40: 2276-2293
        • Feinberg W.M.
        • Albers G.W.
        • Barnett H.J.
        • et al.
        Guidelines for the management of transient ischemic attacks. From the Ad Hoc Committee on Guidelines for the Management of Transient Ischemic Attacks of the Stroke Council of the American Heart Association.
        Circulation. 1994; 89: 2950-2965
        • Giles M.F.
        • Rothwell P.M.
        Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis.
        Lancet Neurol. 2007; 6: 1063-1072
        • Johnston S.C.
        • Rothwell P.M.
        • Nguyen-Huynh M.N.
        • et al.
        Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack.
        Lancet. 2007; 369: 283-292
      1. Special report from the National Institute of Neurological Disorders and Stroke. Classification of cerebrovascular diseases III.
        Stroke. 1990; 21: 637-676
        • Albers G.W.
        • Caplan L.R.
        • Easton J.D.
        • et al.
        Transient ischemic attack—proposal for a new definition.
        N Engl J Med. 2002; 347: 1713-1716
        • Ay H.
        • Koroshetz W.J.
        • Benner T.
        • et al.
        Transient ischemic attack with infarction: a unique syndrome?.
        Ann Neurol. 2005; 57: 679-686
        • Kimura K.
        • Kazui S.
        • Minematsu K.
        • et al.
        Analysis of 16,922 patients with acute ischemic stroke and transient ischemic attack in Japan. A hospital-based prospective registration study.
        Cerebrovasc Dis. 2004; 18: 47-56
        • Deguchi I.
        • Ohe Y.
        • Fukuoka T.
        • et al.
        Relationship of obesity to recanalization after hyperacute recombinant tissue-plasminogen activator infusion therapy in patients with middle cerebral artery occlusion.
        J Stroke Cerebrovasc Dis. 2012; 21: 161-164
        • Wardlaw J.M.
        • Lewis S.
        Carotid stenosis measurement on colour Doppler ultrasound: agreement of ECST, NASCET and CCA methods applied to ultrasound with intra-arterial angiographic stenosis measurement.
        Eur J Radiol. 2005; 56: 205-211
        • Alamowitch S.
        • Eliasziw M.
        • Algra A.
        • et al.
        Risk, causes, and prevention of ischaemic stroke in elderly patients with symptomatic internal-carotid-artery stenosis.
        Lancet. 2001; 357: 1154-1160
        • Madden K.P.
        • Karanjia P.N.
        • Adams Jr., H.P.
        • et al.
        Accuracy of initial stroke subtype diagnosis in the TOAST study. Trial of ORG 10172 in Acute Stroke Treatment.
        Neurology. 1995; 45: 1975-1979
        • Hankey G.J.
        • Warlow C.P.
        Lacunar transient ischaemic attacks: a clinically useful concept?.
        Lancet. 1991; 337: 335-338
        • Chen Z.M.
        • Sandercock P.
        • Pan H.C.
        • et al.
        Indications for early aspirin use in acute ischemic stroke: a combined analysis of 40000 randomized patients from the Chinese acute stroke trial and the international stroke trial. On behalf of the CAST and IST collaborative groups.
        Stroke. 2000; 31: 1240-1249
        • Inatomi Y.
        • Kimura K.
        • Yonehara T.
        • et al.
        DWI abnormalities and clinical characteristics in TIA patients.
        Neurology. 2004; 62: 376-380
        • Purroy F.
        • Montaner J.
        • Rovira A.
        • et al.
        Higher risk of further vascular events among transient ischemic attack patients with diffusion-weighted imaging acute ischemic lesions.
        Stroke. 2004; 35: 2313-2319
        • Coutts S.B.
        • Simon J.E.
        • Eliasziw M.
        • et al.
        Triaging transient ischemic attack and minor stroke patients using acute magnetic resonance imaging.
        Ann Neurol. 2005; 57: 848-854
        • Giles M.F.
        • Albers G.W.
        • Amarenco P.
        • et al.
        Early stroke risk and ABCD2 score performance in tissue- vs time-defined TIA: a multicenter study.
        Neurology. 2011; 77: 1222-1228
        • Arhami Dolatabadi A.
        • Meisami A.
        • Hatamabadi H.
        • et al.
        Improving the prediction of stroke or death after transient ischemic attack (TIA) by adding diffusion-weighted imaging lesions and TIA etiology to the ABCD2 score.
        J Stroke Cerebrovasc Dis. 2013; 22: e24-e30
        • Asimos A.W.
        • Rosamond W.D.
        • Johnson A.M.
        • et al.
        Early diffusion weighted MRI as a negative predictor for disabling stroke after ABCD2 score risk categorization in transient ischemic attack patients.
        Stroke. 2009; 40: 3252-3257
        • Shah S.H.
        • Saver J.L.
        • Kidwell C.S.
        • et al.
        A multicenter pooled, a patient-level data analysis of diffusion-weighed MRI in TIA patients.
        Stroke. 2007; 38: 463
        • Tanaka H.
        • Ueda Y.
        • Hayashi M.
        • et al.
        Risk factors for cerebral hemorrhage and cerebral infarction in a Japanese rural community.
        Stroke. 1982; 13: 62-73
        • PROGRESS Collaborative Group
        Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack.
        Lancet. 2001; 358: 1033-1041
        • Abbott R.D.
        • Donahue R.P.
        • MacMahon S.W.
        • et al.
        Diabetes and the risk of stroke. The Honolulu Heart Program.
        JAMA. 1987; 257: 949-952