Abstract 103: MR Perfusion Lesions in Minor Stroke and TIA Patients Predict New Brain Infarction at 7-days
Background: Although DWI-positive patients who present with transient symptoms have higher day-7 stroke rates than DWI-negative cohorts, little is known about the outcomes of TIA patients with focal perfusion lesions. The aim of the current study is to determine the day-7 recurrent stroke rate in TIA/minor stroke patients who have perfusion lesions on baseline MRI.
Methods: Consecutive TIA and minor stroke (NIHSS < 4) patients who underwent baseline DWI and perfusion imaging as well as day-7 follow-up MRI with DWI and FLAIR at Yeungnam University Stroke Center in Korea were enrolled. Two perfusion parameters (Time to Peak and Mean Transit Time), DWI, ADC and FLAIR sequences were reviewed by 2 raters blinded to clinical outcomes. New brain infarction was defined by the presence of a new lesion on day-7 DWI and FLAIR. Symptomatic carotid and intracranial stenosis was assessed on baseline MRA. New neurological symptoms that occurred within 7 days were recorded.
Results: Sixty-four patients met the inclusion criteria. Mean age was 64±13 years. Median ABCD2 was 4 (IQR: 3-5). At baseline, perfusion lesions were identified in 30 (47%), DWI lesions in 24 (38%) and symptomatic carotid and/or intracranial stenosis in 22 (34%) patients. Nine patients (14%) developed a new brain infarction on day-7 MRI, and all 9 patients had a baseline perfusion lesion. Thus, the rate of new brain infarction in patients with perfusion lesions at baseline was 30% (9/30). Of the 9 patients with new infarcts, 7 (78%) were clinically symptomatic, 5 (56%) had a negative baseline DWI, and 6 (67%) had normal vessel imaging.
Conclusion: Our data suggest that the identification of a focal perfusion lesion during the imaging evaluation of TIA or minor stroke predicts a high rate of recurrent stroke within 1 week, even in the absence of identifiable vessel stenosis or DWI positivity on initial MRI.
Author Disclosures: J. Lee: None. M. Ke: None. M. Mlynash: None. S. Mann: None. M. Inoue: None. N. Kim: None. C. Cereda: None. G. Albers: None. J. Olivot: None.
- © 2015 by American Heart Association, Inc.