Incomplete imaging of transient ischaemic attack increases subsequent stroke risk

Vincent Timpone (Credit: AJR)

Transient ischaemic attacks (TIAs) encountered with incomplete neurovascular imaging in emergency departments (EDs) have been associated with higher odds of subsequent stroke within 90 days, as per a publication in the American Journal of Roentgenology (AJR).

“Increased access to urgent neurovascular imaging in patients with TIA may represent a target that could facilitate detection and treatment of modifiable stroke risk factors,” first author Vincent Timpone (University of Colorado Hospital, Aurora, USA) and colleagues write.

Timpone and his co-authors studied data from the 2016–2017 Medicare Standard Analytical Files, which contain 100% sample claims for Medicare beneficiaries. Information was extracted via International Classification of Diseases (ICD)-10 and Current Procedural Terminology (CPT) codes.

Patients discharged from an ED encounter with a TIA diagnosis—who also underwent brain computed tomography (CT) or brain magnetic resonance imaging (MRI) during or within two days of said encounter—were then identified. Patients were deemed to have complete neurovascular imaging if undergoing cross-sectional vascular imaging of both the brain (brain CT angiography [CTA] or MR angiography [MRA]) and neck (neck CTA or MRA, or carotid ultrasound) during or within two days of their encounter.

Ultimately, from a total of 111,417 national TIA ED encounters, 69,825 (37.3%) showed associations with a complete neurovascular imaging workup.

In addition—when adjusting for patient and hospital characteristics—an incomplete neurovascular imaging workup was associated with increased likelihood of stroke within 90 days of the encounter (odds ratio [OR] 1.3 [95% confidence interval (CI): 1.23–1.38]).

“To ensure that risk factors for stroke can be identified and treated, patients with TIA should have improved access to timely neurovascular imaging,” Timpone and colleagues conclude in their AJR paper.


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