Abstract WP352: Imaging Parameters Alone Predict Early Recurrent Cerebrovascular Endpoints in Patients with Transient Ischemic Attack and Minor Stroke

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Background: There remains lack of consensus on who among minor stroke or transient ischemic attack (MS-TIA) patients constitutes a high-risk group that may be targeted by clinical trials to improve early recurrence risk. We aimed to determine predictors of early recurrent cerebrovascular endpoints (RCVE) among patients with MS-TIA.

Methods: We retrospectively analyzed data from consecutive patients who presented to the emergency room of Columbia University between Jan 1st 2010 - Dec 31st 2014, with MS-TIA (NIHSS 0-3) diagnosed by a neurologist and within 12 hours from onset. The outcome (adjudicated by 3 stroke neurologists) was RCVE (neurological deterioration defined as worsening deficits not attributed to fever or other medical condition or recurrent ischemic stroke or TIA within hospitalization). Our primary predictor was large vessel disease (LVD) stroke subtype. Covariates included demographics, stroke risk factors, symptoms, and imaging parameters. We confirmed our findings in an independent cohort of consecutive MS-TIA patients (NIHSS 0-3) evaluated at Tulane University during the same time period.

Results: The cohort at Columbia University Medical Center included 505 patients; mean length of hospital stay (LOS) 3.2 days, 31 had RCVE (6.1%). The Tulane cohort consisted of 753 patients (mean LOS 4.5 days), 40 had RCVE (5.3%); RCVE predictors on univariate and multivariate analyses in both cohorts were LVD subtype and to a lesser extent positive neuroimaging (Tables 1 and 2). There was an increase in percentage of patients with RCVE with both predictors combined as compared to separate use. When neither predictor was present, the rate of RCVE was very low (Figure). RCVE was associated with poor discharge outcome (mRS≥2).

Conclusion: In patients with MS-TIA, LVD stroke subtype and perhaps positive neuroimaging predict RCVE in two independent cohorts.RCVE was associated with poor functional outcome. Prospective studies are needed to confirm our findings.

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