Rapid diagnosis and treatment of TIA results in low rates of stroke, myocardial infarction and vascular death

• Published in: Neurologia (Barcelona, Spain) Vol. 31; no. 1; p. 18
• Main Authors: Cocho, D, Monell, J, Planells, G, Ricciardi, A C, Pons, J, Boltes, A, Espinosa, J, Ayats, M, Garcia, N, Otermin, P
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 01.01.2016
• Subjects: Aged; Aged, 80 and over; Early Diagnosis; Echocardiography; Female; Humans; Ischemic Attack, Transient - diagnosis; Ischemic Attack, Transient - drug therapy; Ischemic Attack, Transient - mortality; Male; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - epidemiology; Myocardial Infarction - etiology; Prospective Studies; Stroke - epidemiology; Stroke - etiology; Stroke - mortality; Ultrasonography, Doppler, Transcranial; Vascular Diseases - diagnostic imaging; Vascular Diseases - epidemiology; Vascular Diseases - etiology; Ecocardiografía; Stroke; Echocardiography; Infarto cerebral; Transient ischaemic attack; Ataque isquémico transitorio
• ISSN: 1578-1968
• DOI: 10.1016/j.nrl.2014.05.005

The 90-day risk of cerebral infarction in patients with transient ischaemic attack (TIA) is estimated at between 8% and 20%. There is little consensus as to which diagnostic strategy is most effective. This study evaluates the benefits of early transthoracic echocardiography (TTE) with carotid and transcranial Doppler ultrasound in patients with TIA. Prospective study of patients with TIA in an emergency department setting. Demographic data, vascular risk factors, and ABCD(2) score were analysed. TIA aetiology was classified according to TOAST criteria. All patients underwent early vascular studies (<72hours), including TTE, carotid ultrasound, and transcranial Doppler. Primary endpoints were recurrence of stroke or TIA, myocardial infarction (MI), or vascular death during the first year. We evaluated 92 patients enrolled over 24 months. Mean age was 68.3±13 years and 61% were male. The mean ABCD(2) score was 3 points (≥5 in 30%). The distribution of TIA subtypes was as follows: 12% large-artery atherosclerosis; 30% cardioembolism; 10% small-vessel occlusion; 40% undetermined cause; and 8% rare causes. Findings from the early TTE led to a change in treatment strategy in 6 patients (6.5%) who displayed normal physical examination and ECG findings. At one year of follow-up, 3 patients had experienced stroke (3.2%) and 1 patient experienced MI (1%); no vascular deaths were identified. In our TIA patients, early vascular study and detecting patients with silent cardiomyopathy may have contributed to the low rate of vascular disease recurrence.