Urgent carotid duplex and head computed tomography versus ABCD2 score for risk stratification of patients with transient ischemic attack

Objectives: The aim of the study was to prospectively compare the prognostic value of ABCD2 score, urgent carotid ultrasound (CUS), and unenhanced head computed tomography (UHCT) in patients presenting to the emergency department with transient ischemic attack (TIA). Patients and methods: We carried out a prospective observational study including consecutive adult patients with TIA. Each patient underwent ABCD2 score assessment, urgent CUS, and UHCT within 24 h from presentation. The primary outcome was the occurrence of ischemic stroke within 30 days. Results: We included 186 patients with a median age of 75 years and a prevalent male sex (57.5%). During follow-up, 12 ischemic strokes (6.5%) occurred, four (7.1%) in patients with ABCD2 score less than 4 and 8 (6.2%) in those with a score of at least 4. An internal carotid stenosis of at least 50% consistent with the neurological deficit was found in 15 patients (8.1%), and it was associated with a high risk for stroke (odds ratio 4.5, 95% confidence interval 1.1-18.8). An acute ischemic lesion consistent with the neurological deficit was revealed by UHCT in 15 patients (8.1%), and it was associated with a trend of increasing stroke risk (odds ratio 2.5, 95% confidence interval 0.5-12.5). Patients without, with at least one, or with both positive imaging tests showed incremental stroke risk at both 7 (2.5, 12.5, and 33%) and 30 days (5, 12.5, and 33%) (P<0.05 for both). Conclusion: Simple imaging tests showed added prognostic value to ABCD2 score in TIA patients. Urgent CUS together with UHCT should be performed in all TIA patients regardless of ABCD2 score.