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17-09-2012 | Surgery | Article

Minor stroke patients need urgent imaging


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medwireNews: Mild stroke or transient ischemic attack (TIA) results in a surprisingly high rate of disability, say researchers.

The risk for disability at 3 months was particularly high if patients had evidence of vessel occlusion on computed tomography (CT), they report in Stroke.

"Patients with TIA or mild stroke need assessed early with brain and vascular imaging," lead researcher Shelagh Coutts (University of Calgary, Alberta, Canada) told medwireNews.

"Although these patients are considered 'mild' and are not given thrombolysis we found that 1 in 6 patients were disabled at 90 days."

Management of patients with mild stroke has generally focused on preventing a recurrence, which is thought to account for most disability in this subgroup. In their study, Coutts and team did indeed find that a high proportion of patients with recurrent stroke became disabled, defined as a modified Rankin Scale score of at least 2 at 90 days.

In all, 53% of the 36 patients who had a recurrent stroke because disabled, which equated to a 4.4-fold increased risk relative to the 463 patients who did not have a recurrence.

However, the 12% rate of disability among patients without recurrence meant that a much larger absolute number of patients were disabled by a first stroke than by a recurrent stroke.

"This minor stroke/TIA population represents the vast majority of the patients that we see - about 80% of patients are in this category and it represents a large burden on our society," said Coutts.

After accounting for confounders, the risk for disability was increased 2.4-fold in patients who had acute ischemia on CT or vessel occlusion or at least 50% stenosis on CT angiography. The risk was also increased 2.4-fold in patients with ongoing symptoms in the emergency department. Ongoing symptoms were associated with patients' National Institutes of Health Stroke Scale scores, and therefore reflected stroke severity.

Diabetes and female gender were also associated with an increased risk for disability. But among patients with recurrent stroke, only CT findings and ongoing symptoms were predictive.

Coutts said that, based on these findings, the team has initiated a phase II study, assessing safety outcomes in patients with minor stroke/TIA and evidence of vessel occlusion who are treated with low-dose tenecteplase. A randomized controlled trial may follow if the phase II outcomes are positive.

By Eleanor McDermid, Senior medwireNews Reporter

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