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Cerebral Microbleeds and Early Recurrent Stroke After Transient Ischemic Attack Results From the Korean Transient Ischemic Attack Expression Registry

Authors
Lim, Jae-SungHong, Keun-SikKim, Gyeong-MoonBang, Oh YoungBae, Hee-JoonKwon, Hyung-MinPark, Jong-MooLee, Seung-HoonRha, Joung-HoKoo, JaseongYu, Kyung-HoSeo, Woo-KeunLee, Kyung BokLee, Yong-Seok
Issue Date
3월-2015
Publisher
AMER MEDICAL ASSOC
Citation
JAMA NEUROLOGY, v.72, no.3, pp.301 - 308
Indexed
SCIE
SCOPUS
Journal Title
JAMA NEUROLOGY
Volume
72
Number
3
Start Page
301
End Page
308
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/94199
DOI
10.1001/jamaneurol.2014.3958
ISSN
2168-6149
Abstract
IMPORTANCE The risk of early recurrent stroke after transient ischemic attack (TIA) may be modifiable by optimal treatment. Although ABCD(2) scores, diffusion-weighted imaging lesions, and large artery stenosis are well known to predict early stroke recurrence, other neuroimaging parameters, such as cerebral microbleeds (CMBs), have not been well explored in patients with TIA. OBJECTIVE To determine the rate of early recurrent stroke after TIA and its neuroimaging predictors. DESIGN, SETTING, AND PARTICIPANTS In this hospital-based, multicenter prospective cohort study, consecutive patients with TIA were enrolled from 11 university hospitals from July 1, 2010, through December 31, 2012. Patients who were admitted within 24 hours after symptom onset and underwent diffusion-weighted imaging were included. MAIN OUTCOMES AND MEASURES The primary end point was recurrent stroke within 90 days. Baseline demographics, clinical manifestations, neuroimaging findings, and use of antithrombotics or statins also were analyzed. RESULTS A total of 500 patients (mean age, 64 years; male, 291 [58.2%]; median ABCD(2) score, 4) completed 90-day follow-up with guideline-based management: antiplatelets (457 [91.4%]), anticoagulants (74 [14.8%]), and statins (345 [69.0%]). Recurrent stroke occurred in 25 patients (5.0%). Compared with patients without recurrent stroke, those with recurrent stroke were more likely to have crescendo TIA (20 [4.2%] vs 4 [16.0%], P = .03), white matter hyperintensities (146 [30.7%] vs 13 [52.0%], P = .03), and CMBs (36 [7.6%] vs 7 [28.0%], P = .003). On multivariable Cox proportional hazards analysis, CMBs remained as independent predictors for recurrent stroke (hazard ratio, 3.66; 95% CI, 1.47-9.09; P = .005). CONCLUSIONS AND RELEVANCE Immediate and optimal management seems to modify the risk of recurrent stroke after TIA. Cerebral microbleeds may be novel predictors of stroke recurrence, which needs further validation.
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