Journal article
Prognostic value of "tissue-based" definitions of TIA and minor stroke: population-based study
- Abstract:
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OBJECTIVE: Since use of diffusion-weighted imaging (DWI) positivity in the "tissue-based" definition of stroke in patients with a clinical TIA is supported by the high associated 90-day risk of recurrent stroke, we aimed to determine long-term prognostic significance, stratified by etiologic subtype, and whether the same tissue-based distinction is predictive in minor strokes.
METHODS: Consecutive eligible patients with TIA or minor stroke (NIH Stroke Scale [NIHSS] ≤3) in the population-based Oxford Vascular Study underwent brain MRI at baseline. Stroke risk on 10-year follow-up was stratified by NIHSS (0/1 vs 2/3) and Trial of Org 10172 in Acute Stroke Treatment classification of the initial event.
RESULTS: Among 1,033 patients (633 TIA; 400 minor stroke), 248 (24.0%) had acute lesions on DWI (13.9% of TIAs; 40.0% of minor strokes). A positive DWI was associated with an increased 10-year risk of recurrent ischemic stroke after an index TIA (hazard ratio [HR] 2.66, 95% confidence interval [CI] 1.28-5.54, p = 0.009) or a stroke with NIHSS 0-1 (3.03, 1.29-7.08, p = 0.011), but not after a stroke with NIHSS 2-3 (0.70, 0.24-2.10, p = 0.53). Ischemic stroke risk after DWI-positive TIA was at least equivalent to that after DWI-negative stroke (1.81, 0.82-4.00, p = 0.14). Among all patients, DWI positivity was most predictive of 10-year risk after cryptogenic events (4.68, 1.70-12.92, p = 0.003).
CONCLUSION: DWI positivity is associated with an increased long-term risk of recurrent stroke after TIA and minor stroke, supporting a tissue-based definition of minor stroke as well as TIA. Prognostic value is greatest after cryptogenic events.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 342.2KB, Terms of use)
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- Publisher copy:
- 10.1212/WNL.0000000000007531
Authors
- Publisher:
- American Academy of Neurology
- Journal:
- Neurology More from this journal
- Volume:
- 92
- Issue:
- 21
- Article number:
- e2455-e2461
- Publication date:
- 2019-04-17
- Acceptance date:
- 2019-01-22
- DOI:
- EISSN:
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1526-632X
- ISSN:
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0028-3878
- Pmid:
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30996061
- Language:
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English
- Pubs id:
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pubs:993302
- UUID:
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uuid:420d14d1-7e7c-48c7-8206-4398c243379b
- Local pid:
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pubs:993302
- Source identifiers:
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993302
- Deposit date:
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2019-08-27
- ARK identifier:
Terms of use
- Copyright holder:
- Hurford et al
- Copyright date:
- 2019
- Notes:
- © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
- Licence:
- CC Attribution (CC BY)
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