• Jason K Wasserman, Jeffrey J Perry, Marco L A Sivilotti, Jane Sutherland, Andrew Worster, Marcel Émond, Albert Y Jin, Wieslaw J Oczkowski, Demetrios J Sahlas, Heather Murray, Ariane MacKey, Steve Verreault, George A Wells, Dar Dowlatshahi, Grant Stotts, Ian G Stiell, and Mukul Sharma.
• From the Department of Pathology and Laboratory Medicine (J.K.W.), Ottawa Hospital Health Research Institute (J.K.W., J.J.P., D.D., I.G.S.), Department of Emergency Medicine (J.J.P., I.G.S.), Department of Epidemiology and Community Medicine (G.A.W.), and Division of Neurology (D.D., G.S.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine and of Pharmacology and Toxicology (M.L.A.S.), Department of Neurology (A.Y.J.), and Department of Emergency Medicine (H.M.), Queen's University, Kingston, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (J.S.); Division of Emergency Medicine (A.W.), Division of Neurology (W.J.O., D.J.S.), and Population Health Research Institute (M.S.), Department of Neurology, McMaster University, Hamilton, Ontario, Canada; Department of Emergency Medicine, Université Laval, Quebec, Quebec, Canada (M.É.); and Department of Neurology, Hôpital de l'Enfant-Jesus, Quebec City, Quebec, Canada (A.M., S.V.).
• Stroke. 2015 Jan 1; 46 (1): 114-9.

Background And PurposeIschemia on computed tomography (CT) is associated with subsequent stroke after transient ischemic attack. This study assessed CT findings of acute ischemia, chronic ischemia, or microangiopathy for predicting subsequent stroke after transient ischemic attack.MethodsThis prospective cohort study enrolled patients with transient ischemic attack or nondisabling stroke that had CT scanning within 24 hours. Primary outcome was subsequent stroke within 90 days. Secondary outcomes were stroke at ≤2 or >2 days. CT findings were classified as ischemia present or absent and acute or chronic or microangiopathy. Analysis used Fisher exact test and multivariate logistic regression.ResultsA total of 2028 patients were included; 814 had ischemic changes on CT. Subsequent stroke rate was 3.4% at 90 days and 1.5% at ≤2 days. Stroke risk was greater if baseline CT showed acute ischemia alone (10.6%; P=0.002), acute+chronic ischemia (17.4%; P=0.007), acute ischemia+microangiopathy (17.6%; P=0.019), or acute+chronic ischemia+microangiopathy (25.0%; P=0.029). Logistic regression found acute ischemia alone (odds ratio [OR], 2.61; 95% confidence interval [CI[, 1.22-5.57), acute+chronic ischemia (OR, 5.35; 95% CI, 1.71-16.70), acute ischemia+microangiopathy (OR, 4.90; 95% CI, 1.33-18.07), or acute+chronic ischemia+microangiopathy (OR, 8.04; 95% CI, 1.52-42.63) was associated with a greater risk at 90 days, whereas acute+chronic ischemia (OR, 10.78; 95% CI, 2.93-36.68), acute ischemia+microangiopathy (OR, 8.90; 95% CI, 1.90-41.60), and acute+chronic ischemia+microangiopathy (OR, 23.66; 95% CI, 4.34-129.03) had greater risk at ≤2 days. Only acute ischemia (OR, 2.70; 95% CI, 1.01-7.18; P=0.047) was associated with a greater risk at >2 days.ConclusionsIn patients with transient ischemic attack/nondisabling stroke, CT evidence of acute ischemia alone or acute ischemia with chronic ischemia or microangiopathy was associated with increased subsequent stroke risk within 90 days.© 2014 American Heart Association, Inc.

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