CT Scan May Predict Risk of Second Stroke

Jeff Perry, MD, MSc, CCFP-EM Associate Professor, Department of Emergency Medicine Senior Scientist, Ottawa Hospital Research Institute Research Chair in Emergency Neurological Research, University of Ottawa Emergency Physician, The Ottawa Hospital Epidemiology Program, F6 The Ottawa Hospital, Civic Campus Ottawa, Ontario MedicalResearch.com Interview with
Jeff Perry, MD, MSc, CCFP-EM

Associate Professor, Department of Emergency Medicine
Senior Scientist, Ottawa Hospital Research Institute
Research Chair in Emergency Neurological Research, University of Ottawa Emergency Physician, Epidemiology Program,
The Ottawa Hospital, Ottawa, Ontario

Medical Research: What is the background for this study? What are the main findings?

Dr. Perry: Currently many patients with a TIA or non-disabling stroke have a subsequent stroke which may be very disabling or result in death prior to having all investigations completed and maximal stroke prevention implemented.  Prior to this study, the utility of CT findings for predicting subsequent stroke was incompletely understood in this patient population.

Dr. Perry:
Main findings: Compared to patients without ischemia, the probability of another stroke occurring within 90 days of the initial episode was:

  • 2.6 times greater if the CT image revealed newly damaged tissue due to poor circulation (acute ischemia);
  • 5.35 times greater if tissue was previously damaged (chronic ischemia) in addition to acute ischemia;
  • 4.9 times greater if any type of small vessel damage occurred in the brain, such as narrowing of the small vessels (microangiopathy), in addition to acute ischemia;
  • 8.04 times greater if acute and chronic ischemia occurred in addition to microangiopathy.

Medical Research: What should clinicians and patients take away from your report?

Dr. Perry: All patients should get a CT scan of their brain after a TIA or non-disabling stroke. Images can help healthcare professionals identify patterns of damage associated with different levels of risk for a subsequent stroke.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Perry: Next steps are to try to incorporate these findings in one or more of the current risk scores based on clinical findings to better identify a given patient’s risk for an impending subsequent stroke so that we can ensure maximal stroke prevention is undertaken before a subsequent event.
Citation:
upcoming AHA publication

Computed tomography identifies patients at high risk for stroke after transient ischemic attack/non-disabling stroke: a prospective, multi-center cohort study.
Wasserman JK1, Perry JJ2, Sivilotti ML1, Sutherland J1, Worster A1, Emond M1, Jin AY1, Oczkowski WJ1, Sahlas DJ1, Murray H1, MacKey A1, Verreault S1, Wells GA1, Dowlatshahi D1, Stotts G1, Stiell IG1, Sharma M1.
Stroke.
2014 Dec 4. pii: STROKEAHA.114.006768. [Epub ahead of print]

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