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Bruce Ovbiagele, MD; Salvador Cruz-Flores, MD; Michael J. Lynn, MS; Marc I. Chimowitz, MD; for the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Study Group

Arch Neurol. 2008;65(6):733-737.

Background  Little is known about short-term vascular risk after transient ischemic attack (TIA) caused by intracranial atherosclerosis.

Objectives  To quantify the early risk of ischemic stroke in the territory of a stenotic intracranial artery after TIA and to identify clinical and imaging features associated with increased risk of stroke in the territory among patients with TIA.

Design  Cohort study.

Setting  Academic research.

Patients  The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) study enrolled patients having TIA or nondisabling stroke within the preceding 3 months and demonstrating corresponding 50% to 99% stenosis of a major intracranial artery on angiography.

Main Outcome Measures  We calculated the cumulative risk of stroke in the territory of the symptomatic artery during the first 90 days after randomization among patients having TIA alone as a qualifying event compared with patients having stroke alone. We assessed selected factors for association with stroke among patients having TIA as the qualifying event.

Results  The 90-day risk of ischemic stroke in the arterial territory was 6.9% (95% confidence interval, 4.2%-11.2%) after TIA compared with 4.7% (95% confidence interval, 2.7%-8.4%) after stroke (P =.32). Among patients having TIA alone as the qualifying event, 60.0% (15 of 25) of all strokes in the arterial territory occurred in the first 90 days compared with 34.4% (11 of 32) among patients having stroke alone as the qualifying event (P =.05). Among subjects with TIA, the presence of cerebral infarct on baseline neuroimaging was the only statistically significant predictor of higher risk of early stroke (hazard ratio, 4.7; 95% confidence interval, 1.4-15.5; P =.006).

Conclusions  Among individuals having intracranial atherosclerotic disease with TIA, most subsequent strokes in the territory of a stenotic intracranial artery occur early (ie, 90 days). Prompt management of TIA in patients having intracranial stenosis, particularly those demonstrating cerebral infarction on brain imaging, is indicated.

Author Affiliations: Stroke Center and Department of Neurology, UCLA Medical Center, University of California at Los Angeles (Dr Ovbiagele); Souers Stroke Institute, Department of Neurology, Saint Louis University School of Medicine, St Louis, Missouri (Dr Cruz-Flores), and Department of Biostatistics, Rollins School of Public Health (Mr Lynn), and Department of Neurology, School of Medicine (Dr Chimowitz), Emory University, Atlanta, Georgia.