Transient brain ischemic symptoms and the presence of ischemic lesions at neuroimaging: Results from the READAPT study
Authors: Ornello Raffaele , Foschi Matteo , De Santis Federico , Romoli Michele , Tassinari Tiziana , Saia Valentina , Cenciarelli Silvia , Bedetti Chiara , Padiglioni Chiara , Censori Bruno , Puglisi Valentina , Vinciguerra Luisa , Guarino Maria , Barone Valentina , Zedde Maria Luisa , Grisendi Ilaria , Diomedi Marina , Bagnato Maria Rosaria , Petruzzellis Marco , Mezzapesa Domenico Maria , Di Viesti Pietro , Inchingolo Vincenzo , Cappellari Manuel , Zenorini Mara , Candelaresi Paolo , Andreone Vincenzo , Rinaldi Giuseppe , Bavaro Alessandra , Cavallini Anna , Moraru Stefan , Querzani Pietro , Terruso Valeria , Mannino Marina , Scoditti Umberto , Pezzini Alessandro , Frisullo Giovanni , Muscia Francesco , Paciaroni Maurizio , Mosconi Maria Giulia , Zini Andrea , Leone Ruggiero , Palmieri Carmela , Cupini Letizia Maria , Marcon Michela , Tassi Rossana , Sanzaro Enzo , Paci Cristina , Viticchi Giovanna , Orsucci Daniele , Falcou Anne , Diamanti Susanna , Tarletti Roberto , Nencini Patrizia , Rota Eugenia , Sepe Federica Nicoletta , Ferrandi Delfina , Caputi Luigi , Volpi Gino , La Spada Salvatore , Beccia Mario , Rinaldi Claudia , Mastrangelo Vincenzo , Di Blasio Francesco , Invernizzi Paolo , Pelliccioni Giuseppe , De Angelis Maria Vittoria , Bonanni Laura , Ruzza Giampietro , Caggia Emanuele Alessandro , Russo Monia , Tonon Agnese , Acciarri Maria Cristina , Anticoli Sabrina , Roberti Cinzia , Manobianca Giovanni , Scaglione Gaspare , Pistoia Francesca , Fortini Alberto , De Boni Antonella , Sanna Alessandra , Chiti Alberto , Barbarini Leonardo , Masato Maela , Del Sette Massimo , Passarelli Francesco , Bongioanni Maria Roberta , Toni Danilo , Ricci Stefano , Sacco Simona , De Matteis Eleonora 
Published: November 2024

Background:

According to the literature, about one third of patients with brain ischemic symptoms lasting <24 h, which are classified as Transient ischemic attacks (TIAs) according to the traditional “time-based” definition, show the presence of acute ischemic lesions at neuroimaging. Recent evidence has shown that the presence of acute ischemic lesions at neuroimaging may impact on the outcome of patients with transient ischemic symptoms treated with dual antiplatelet treatment (DAPT). This uncertainty is even more compelling in recent years as short-term DAPT has become the standard treatment for any non-cardioembolic TIA or minor ischemic stroke.

Methods:

This is a pre-specified subgroup analysis from a prospective multicenter real-world study (READAPT). The analysis included patients with time-based TIA—that is, those with ischemic symptoms lasting <24 h—who started DAPT. In the whole population, we assessed the presence of acute brain ischemic lesions at neuroimaging and their association with the ABCD2 score. To assess the impact of acute brain ischemic lesions on 90-day prognosis, we performed a propensity score matching of patients with and without those lesions. We adopted a primary effectiveness outcome which was a composite of new stroke/TIA events and death due to vascular causes at 90 days.

Results:

We included 517 patients—324 (62.7%) male—with a median (interquartile range—IQR) age of 74 (IQR = 65–81) years; 144 patients (27.9%) had acute brain ischemic lesions at neuroimaging. The proportion of patients with brain ischemic lesions did not vary according to the ABCD2 score. At follow-up, 4 patients with brain ischemic lesions (2.8%) and 21 patients without lesions (5.6%) reported the primary effectiveness outcome, which was similar between the groups before ( p = 0.178) and after matching ( p = 0.518).

Conclusions:

In our population, patients with transient ischemic symptoms and acute ischemic lesions at brain magnetic resonance imaging (MRI) had a risk of recurrent ischemic events similar to those without lesions. The risk of recurrent ischemic events was low in both groups.