PROGNOSIS FOR PATIENTS FOLLOWING A TRANSIENT ISCHEMIC ATTACK WITH AND WITHOUT A CEREBRAL INFARCTION ON BRAIN CT

被引:43
作者
ELIASZIW, M
STREIFLER, JY
SPENCE, JD
FOX, AJ
HACHINSKI, VC
BARNETT, HJM
机构
[1] JOHN P ROBARTS RES INST,LONDON,ON N6A 5K8,CANADA
[2] UNIV WESTERN ONTARIO,DEPT EPIDEMIOL & BIOSTAT,LONDON,ON N6A 3K7,CANADA
[3] UNIV WESTERN ONTARIO,DEPT CLIN NEUROL SCI,LONDON,ON N6A 3K7,CANADA
[4] UNIV WESTERN ONTARIO,DEPT DIAGNOST RADIOL,LONDON,ON N6A 3K7,CANADA
[5] VICTORIA HOSP,HYPERTENS RES UNIT,LONDON,ON N6A 4G5,CANADA
关键词
D O I
10.1212/WNL.45.3.428
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Although cerebral infarctions are commonly observed on brain CTs of patients with TIAs, their prognostic importance is unknown. Method: The association between appropriately sited brain infarctions (ie, lesions located in the anterior circulation of the brain and ipsilateral to the symptomatic stenosed carotid artery) visualized on CT and the risk of subsequent stroke was assessed by Cox proportional hazards regression in 164 patients presenting with TIA (and no history of previous stroke) and severe angiographically defined carotid stenosis (70 to 99%) from the North American Symptomatic Carotid Endarterectomy Trial. Results: Patients with a TIA and CT-verified brain lesions were older and were more likely to have higher degrees of carotid stenosis and carotid plaque ulceration, a longer duration of symptoms, and a history of hypertension. With regard to prognosis, after adjusting for all known risk factors (patient characteristics) in a regression analysis, the presence of ischemic lesions observed on CT was not associated with an increased risk of ipsilateral stroke at 2 years (adjusted hazard ratio = 1.00; 95% CI: 0.39 to 2.58; p value = 0.99). Conclusion: Considered in combination with other patient characteristics, the mere presence of an appropriately sited cerebral infarction on CT does not alter the prognosis (risk of ipsilateral strokes) of severely stenosed patients with TIA. Therefore, there is no clinical rationale in differentiating patients with TIA on the basis of CT findings alone.
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页码:428 / 431
页数:4
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