Patients with transient ischemic attack (TIA) and abnormal transcranial Doppler (TCD) findings face a high risk of further cerebral and cardiovascular ischemic events, according to research published in BMC Medical Imaging.
A research team from the Technical University of Munich in Germany sought to evaluate the value of extracranial Doppler (ECD) and TCD as well as duplex ultrasound in predicting clinical outcome after TIA. The study included 176 consecutive TIA patients admitted to the institution's stroke unit (BMC Med Imaging, July 30).
All patients received diffusion-weighted imaging and standardized ECD and TCD. New vascular events were later recorded at a median follow-up of 27 months, according to the researchers.
Of the 176 patients, 22 (13.8%) experienced an ischemic stroke or TIA. Five (3.1%) had a myocardial infarction or acute coronary syndrome, and five (3.1%) received arterial revascularization.
ECD found extracranial stenosis ≥ 50% or occlusions in 34 (19.3%) patients, and TCD showed intracranial stenosis in 15 (9.2%) cases and collateral flow patterns due to extracranial stenosis in five (3.1%) cases, according to the study team.
From multivariate analysis, the researchers identified these abnormal ECD and TCD findings as predictors of new cerebral ischemic events (for ECD: hazard ratio, 4.30; 95% CI: 1.75-10.57; p = 0.01; for TCD: hazard ratio, 4.73; 95% CI: 1.86-12.04; p = 0.01). In addition, abnormal TCD findings were also predictive of cardiovascular ischemic events (hazard ratio, 18.51; 95% CI: 3.49-98.24; p = 0.001).
"The present study confirms the high risk of further cerebral ischemic events in TIA patients with ultrasonographic evidence of extracranial or intracranial steno-occlusive disease during medium- to long-term follow-up," the authors concluded. "As pathological TCD findings additionally predict new cardiovascular ischemic events, routine screening tests for coronary artery disease and aggressive prevention therapies should be considered in this subgroup of TIA patients. ECD and TCD are important diagnostic procedures in patients with TIA."
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