Transcranial color‐coded sonography to predict recurrent transient ischaemic attack/stroke

Background and purpose Patients with transient ischaemic attack ( TIA ) with a high risk of imminent stroke can be identified with the ABCD 2 score and findings on MRI and CT angiography. The predictive value of transcranial color‐coded sonography ( TCCS ) has not been evaluated in this setting. Methods A retrospective analysis was conducted of patients consecutively treated for TIA or minor stroke in a TIA clinic within 24 h of symptom onset. Agreement between TCCS and MRI three‐dimensional time‐of‐flight images for the diagnosis of proximal (internal carotid artery, vertebral artery, basilar artery, circle of Willis and main stem of the middle cerebral artery) >50% stenosis or occlusion of the intracranial symptomatic artery was evaluated. The sensitivity, specificity, predictive values and likelihood ratio of TCCS for predicting recurrent TIA /stroke at 7 days were calculated. Results Of 159 patients with a TIA or minor stroke within the last 24 h, 142 had a readable acoustic temporal bone window (89.3%). TCCS and MRI were performed within 4 h of each other in 116 patients. MRI showed a symptomatic proximal intracranial steno‐occlusive lesion in six patients. Agreement between MRI and TCCS was perfect (κ coefficient = 1). Recurrent TIA /stroke occurred in 10 patients (eight TIA and two minor strokes). All recurrences occurred within 24 h of symptom onset. A symptomatic proximal intracranial steno‐occlusive lesion was found on TCCS in 4/10 patients with recurrence and 3/132 patients without recurrence [sensitivity 40%; specificity 97.7%; likelihood ratio 18.1; odds ratio (95% CI ) adjusted for ABCD 2 score 31.5 (4.5–218.6)]. Conclusion Our study shows that TCCS can be used to guide triage of patients with TIA .