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Transcranial Doppler ultrasonography predicts cardiovascular events after TIA

DOI: 10.1186/1471-2342-9-13

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Abstract:

176 consecutive TIA patients admitted to the Stroke Unit were recruited in the study. All patients received diffusion-weighted imaging, standardized ECD and TCD. At a median follow-up of 27 months, new vascular events were recorded.22 (13.8%) patients experienced an ischemic stroke or TIA, 5 (3.1%) a myocardial infarction or acute coronary syndrome, and 5 (3.1%) underwent arterial revascularization. ECD revealed extracranial ≥ 50% stenosis or occlusions in 34 (19.3%) patients, TCD showed intracranial stenosis in 15 (9.2%) and collateral flow patterns due to extracranial stenosis in 5 (3.1%) cases. Multivariate analysis identified these abnormal ECD and TCD findings as predictors of new cerebral ischemic events (ECD: hazard ratio (HR) 4.30, 95% confidence interval (CI) 1.75 to 10.57, P = 0.01; TCD: HR 4.73, 95% CI 1.86 to 12.04, P = 0.01). Abnormal TCD findings were also predictive of cardiovascular ischemic events (HR 18.51, 95% CI 3.49 to 98.24, P = 0.001).TIA patients with abnormal TCD findings are at high risk to develop further cerebral and cardiovascular ischemic events.After a transient ischemic attack (TIA), patients are at high risk to develop further vascular events. The risk of stroke within the first 90 days after TIA is 4% to 20%, with half of the events occurring within the first 2 days [1-6]. Consequently, the early risk of stroke after TIA is comparable to, or even higher than, the short-term risk of myocardial infarction (MI) and major cardiovascular complications in patients presenting with chest pain [7]. Several clinical characteristics such as advanced age [2,8-10], diabetes mellitus [2,9], hypertension [9,10], weakness [2,9,10], speech impairment [2,9,10], prolonged symptom duration [2,8-10], evidence of acute ischemia on brain imaging [3,6,11,12], extracranial or intracranial large-artery occlusive disease [3,6,13-15], and cardioembolism [14], have been reported to be independently associated with a higher incidence of early subsequent stroke a

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