A total of 40 patients (23 males,
17 females; age range 35-90 years) have been referred to hospital with TIA.
Only four pateints (10%) underwent MRI studies,
none of which was done within time (0%).
None of the study group had a vascular territory confirmed nor a contraindication for MRI identified.
CT scans were done for 38 patients (95%) of which 35 patients (92%) had their CT done within time.
Of the 38 CT studies which were done,
CT confirmed ischaemia in only 7 patients (18%) whereas CT studies for the rest of the patients were normal (31,
82%).
Two patients with ABCD2<4 and two patients with ABCD2≥4 underwent MRI studies after 7 days and 2 days respectively after their CT results were found normal.
MRI of one of the patients belonging to the first group revealed focal ischaemic changes of carotid artery territory.
The remaining three MRI studies were normal.
All 40 patients,
after a specialist assessment on presentation,
were found to have non-cardio-embolic,
carotid-territory minor stroke and they were all deemed fit for carotid intervention if indicated.
Neither of the brain imaging modalities (CT/MRI) confirmed vertebro-basillar territory ischaemia.
Accordingly,
all the 40 patients who were referred with TIA needed carotid imaging [2].
Eighteen carotid studies were done overall (45%),
6 (33%) were done within time.
For two patients (5%) there were clear justified reasons why carotid duplex was not performed.
One patient failed to attend the appointment.
The second patient has had CTA which revealed no critical stenosis of the carotid artery that merits surgical intervention.
However,
this CTA was not done within time (done within 5 days for ABCD2 score of 4).
Half of the patients (20,
50%) did not undergo carotid duplex studies for non justifiable reasons (no mention of patient’s non fitness for carotid intervention,
no alternative vascular imaging used and no confirmation of vertebral-territory involvement).
Fifteen out of the total eighteen patients who underwent carotid duplex studies did not show severe carotid stenosis (NASCET<50%,
ECST<70%).
The remaining three patients (17%) had severe stenosis (NASCET 50-99%,
ECST 70-99%).
No vascular referral was done within time for either one. Table 3 shows the distribution of the patients according to their ABCD2 score
Table 3: patients' distribution accoridng to their ABCD2 score
ABCD2
|
Number (%)
|
1
2
3
4
5
6
|
3 (7.5%)
4 (10%)
9 (22.5%)
13 (32.5%)
7 (17.5%)
4 (10%)
|
16 (40%) patients presented with ABCD2<4 (9 males,
7 females; age range 35-85 years) whereas 24 (60%) patients presented with ABCD2≥4 (14 males,
10 females; age range 46-90 years).
Table 4 shows patients’ demographics for all patients and two subgroups,
and table 5 shows imaging outcome for all patients and the two subgroups.
Table 4: patients' demographics
ABCD2 score
|
demographics
|
1-6 (all)
|
40 (100%)
males 23 (57%)
females 17 (43%)
age range 35-90 years
average 71
|
<4
|
16 (40%)
males 9 (56%)
females 7 (44%)
age range 35-85 years
average 73
|
≥4
|
24 (60%)
males 14 (58%)
females 10 (42%)
age range 46-90 years
average 78
|
Table 5: imaging outcome
ABCD2 score
|
MRI
|
CT
|
Carotid doppler
|
Within time
|
overall
|
Within time
|
overall
|
Within time
|
overall
|
<4 (16)
|
0 (0%)
|
0 (0%)
|
13 (81%)
|
14 (87%)
|
1 (6%)
|
5 (31%)
|
≥4 (24)
|
0 (0%)
|
4 (16%)
|
22 (91%)
|
24(100%)
|
5 (20%)
|
13 (54%)
|
All (40)
|
0 (0%)
|
4 (16%)
|
35 (92%)
|
38 (95%)
|
6 (33%)
|
18 (45%)
|