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Arch Neurol. 2008 Jun;65(6):733-7. doi: 10.1001/archneur.65.6.733.

Early stroke risk after transient ischemic attack among individuals with symptomatic intracranial artery stenosis.

Author information

1
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

Abstract

BACKGROUND:

Little is known about short-term vascular risk after transient ischemic attack (TIA) caused by intracranial atherosclerosis.

OBJECTIVES:

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.

DESIGN:

Cohort study.

SETTING:

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.

MAIN OUTCOME MEASURES:

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.

PMID:
18541793
DOI:
10.1001/archneur.65.6.733
[Indexed for MEDLINE]

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