Transcranial color-coded sonography to predict recurrent transient ischaemic attack/stroke

Authors


Correspondence: N. Nasr, Service de Neurologie Vasculaire, Hôpital Rangueil, 1 av Prof Jean Poulhès, 31059 Toulouse Cedex 9, France (tel.: +33561322641; fax: +33561322926; e-mail: nathalie.nasr@orange.fr; nasr.n@chu-toulouse.fr).

Abstract

Background and purpose

Patients with transient ischaemic attack (TIA) with a high risk of imminent stroke can be identified with the ABCD2 score and findings on MRI and CT angiography. The predictive value of transcranial color-coded sonography (TCCS) has not been evaluated in this setting.

Methods

A retrospective analysis was conducted of patients consecutively treated for TIA or minor stroke in a TIA clinic within 24 h of symptom onset. Agreement between TCCS and MRI three-dimensional time-of-flight 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 the intracranial symptomatic artery was evaluated. The sensitivity, specificity, predictive values and likelihood ratio of TCCS for predicting recurrent TIA/stroke at 7 days were calculated.

Results

Of 159 patients with a TIA or minor stroke within the last 24 h, 142 had a readable acoustic temporal bone window (89.3%). TCCS and MRI were performed within 4 h of each other in 116 patients. MRI showed a symptomatic proximal intracranial steno-occlusive lesion in six patients. Agreement between MRI and TCCS was perfect (κ coefficient = 1). Recurrent TIA/stroke occurred in 10 patients (eight TIA and two minor strokes). All recurrences occurred within 24 h of symptom onset. A symptomatic proximal intracranial steno-occlusive lesion was found on TCCS in 4/10 patients with recurrence and 3/132 patients without recurrence [sensitivity 40%; specificity 97.7%; likelihood ratio 18.1; odds ratio (95% CI) adjusted for ABCD2 score 31.5 (4.5–218.6)].

Conclusion

Our study shows that TCCS can be used to guide triage of patients with TIA.

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