London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 727 723 Acute cerebrovascular events (ACE): TIA and minor strokes Clinical Significance of Perfusion Weighted Imaging Findings in Patients with Crescendo Transient Cerebral Ischemic Attacks J. LEE1, N.Y. KIM2, S.J. LEE3, W.M. BYUN45 Yeungnam University Medical Center, Daegu, SOUTH KOREA1, Yeungnam University Medi-cal Center, Daegu, SOUTH KOREA2, Yeungnam University Medical Center, Daegu, SOUTH KO-REA3, Yeungnam University Medical Center, Daegu, SOUTH KOREA4 Background Although multiple transient ischemic attacks (TIAs) within a few days are associated with a high risk of developing a complete stroke, the underlying pathomechanisms in this group are still debat-able. We aim to assess the imaging findings of patients who have crescendo TIAs and investigate the clinical usefulness of perfusion weighted MRI (PWI) as a predictor of new lesion in these cases. Methods From February 2004 to March 2012, consecutive patients with history of crescendo TIAs who un-derwent brain MRI less than 48 hours from onset of the last episode were prospectively enrolled. Crescendo TIAs were defined as two or more episodes within 24 hours, with complete recovery af-ter each episode. Clinical and brain imaging findings were compared between patients who had cre-scendoTIAs with DWI positive findings and without DWI negative. Results Among 161 patients (mean age, 62 years old; 65 men vs. 96 women) enrolled in the study, 82 (50.9%) had baseline diffusion weighted MRI (DWI) abnormalities. The lesions were detected in the basal ganglia of 47 (57.3%) patients, and in the pons of 5 (6.1%) patients in the DWI positive group. Female gender (OR 2.094, 95% CI 1.012 to 4.333, p=0.046) and elevated homocysteine levels (OR 1.103, 95% CI 1.022 to 1.190, p=0.012) were significantly associated with DWI abnormalities in a multivariate analysis. Perfusion weighted imaging (PWI) were performed in 64 patients. Higher pro-portion of follow-up DWI positive were identified in patients who had baseline PWI positive (81.6% vs. 34.6%, p<0.001). Baseline PWI abnormality was an independent predictor of follow up DWI ab-normalities in a multivariate analysis (OR 6.905, 95% CI 2.147 to 22.202, p=0.001). Conclusions These results demonstrate that crescendo TIAs are associated with new lesions on DWI in 51% of the cases and the basal ganglia are the most commonly involved. Additionally baseline PWI abnor-mality is a significant predictor for follow up DWI abnormality. 724 Acute cerebrovascular events (ACE): TIA and minor strokes Transcranial colour-coded sonography to predict recurrent stroke/TIA N. NASR1, G. Ssi-Yan-Kai2, B. GUIDOLIN3, F. BONNEVILLE4, V. LARRUE5 Department of Vascular Neurology. University of Toulouse. INSERM 1048, TOULOUSE, FRANCE1, Department of Neuroradiology. Toulouse University Hospital., TOULOUSE, FRANCE2, Department of Vascular Neurology. Toulouse University Hospital., TOULOUSE, FRANCE3, Department of Neuroradiology. University of Toulouse. INSERM U825, TOULOUSE, FRANCE4, Department of Vascular Neurology. University of Toulouse. INSERM 1048, TOU-LOUSE, FRANCE5 Background. Patients with recent transient ischaemic attack (TIA) are at risk of imminent stroke. The clinical ABCD2 score and findings on MRI and CT-angiography can be used to identify patients at risk. The predictive value of transcranial colour-coded sonography (TCCS) has not been evaluated in this set-ting. Methods. We conducted a retrospective analysis of patients consecutively treated for TIA or minor stroke in a TIA clinic within 24h of symptom onset. Agreement between TCCS and MRI 3D TOF 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 intracranial symptomatic ar-tery was evaluated using the kappa statistics. We calculated the sensitivity and specificity of TCCS for predicting recurrent TIA/stroke at 7 days. Results. Of 314 patients admitted to the clinic during the study period, 159 had confirmed TIA or minor stroke and were treated within 24h of symptom onset. A readable acoustic temporal bone window was found in 142/159 (89.3%) patients. TCCS and MRI were performed within 4h from each other in 116 patients. MRI showed a proximal steno-occlusive lesion of intracranial symptomatic artery in 6 patients. Agreement between MRI and TCCS was perfect (kappa=1). Recurrent TIA/stroke oc-curred in 10 patients (8 TIA and 2 minor strokes). All recurrences occurred within 24h of symptom onset. A steno-occlusive lesion of the symptomatic artery was found on TCCS in 4/10 patients with recurrence and 3/132 patients without recurrence (P<0.001; sensitivity=40%; specificity=97.7%; odds ratio 95% CI adjusted for ABCD2 score: 31.5 4.5 to 218.6) Conclusion. Our study shows that TCCS can be used to guide triage of patients with TIA. The use of TCCS is however limited by the lack of acoustic window in approximately 10% of patients.
Karger_ESC London_2013
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