Evaluation Of The Risk Of Cerebral Infarction Resulting From Transient Ischemic Attack In The Short Term

Backgroud and ObjectiveTransient ischemic attack(TIA)is a significant and dangerous ischemic stroke warning event in clinic.Its traditional definition was that there was a transient neurological deficit in the area of cerebrovascular distribution.At the same time,the symptom was not more than 24 hours.The definition was put forward at the Princeton conference in 1965.In the continuous practice of medicine,the 24 hour definition of 1975 was formally adopted,and its specific definition was recorded in the revised edition of the classification of cerebrovascular diseases,which was formulated by the National Institutes of health.Its 24 hour definition also followed the TIA(2007 Edition)diagnostic standard formulated by the Chinese society of Chinese Medical Association neuropathy.The specific standard is that TIA is an excessive or transient focal cerebral or retinal dysfunction caused by intracranial vascular lesions.The clinical symptoms generally hold 10~15min,more than 1 hour,and not more than 24 hours;No neurological deficit symptoms and signs of structural imaging(CT,MRI)examination without responsible lesions.However,the latest application in clinical TIA diagnostic criteria has no longer emphasized the limitation of 24 hours,but more emphasis on imaging assisted diagnosis,emphasizing the strict distinction within cerebral infarction.The proportion and risk of cerebral infarction after TIA in short term is larger than heart disease,which is confirmed in many studies and is also a recognized clinical event.The risk of secondary infarction after TIA has not been paid enough attention.The latest research data show that the previous risk assessment of TIA is low,and today's data analysis suggests that the secondary infarction risk in TIA is higher than before,and TIA has an earlier stroke.Therefore,how to identify the risk and prognosis of TIA early,quickly and simply is very important for clinical work.Johnston et al creatively put forward the ABCD~2score in 2007 and applied it to clinical work to assess the risk of TIA infarction.To better assess the risk of TIA,the researchers graded the risk of TIA patients.According to the score,the 0~3 scores were classified as the low risk group,the 4~5scores were classified into the middle risk group,and the 6~7 scores were classified as high risk groups.In predicting the risk of cerebral infarction at the two time nodes of the 7 day of 2 days,the domestic researchers found that the area under the curve of the ABCD score(AUC)was lower than that of the ABCD~2 score,indicating that the ABCD~2 phase had a better predictive value than the ABCD score.Ong and other studies also found that ABCD~2 score had better sensitivity and predictive value for TIA risk,especially for prediction of stroke within 7 d.But there are some researchers who agree that the specificity and sensitivity of predicting the occurrence of cerebral infarction in TIA is not as high as the ABCD~2 score alone.However,some research parameters or factors were combined into the ABCD~2 score.The study found that the joint assessment could improve the specificity of the sensitivity to the risk prediction of stroke in varying degrees.Therefore,156 patients with TIA were included in this study.The value of ABCD~2 score combined with the history of TIA and the assessment of the risk of short-term cerebral infarction by TIA was reviewed.The purpose of this study is to evaluate the risk of cerebral infarction in TIA 1week by using the ABCD~2 scoring method combined with TIA medical history or vascular examination,and to provide some ideas or basis for the clinical TIA risk screening and clinical diagnosis and treatment.Objects and MethodsDuring the neurology department of the Fifth Affiliated Hospital of Zhengzhou University,December 2015-2017,156 cases of TIA patients in the intracranial and external artery system were recorded.The ABCD~2 score of each TIA patient was recorded,and all patients had a history of TIA symptoms within 1 week before admission;all patients who were diagnosed as TIA were performed carotid artery blood vessels,Ultrasound and transcranial Doppler(TCD)ultrasound examination.According to the clinical and patient's actual conditions,magnetic resonance angiography(MRA)or CT angiography(CTA)was used to perform the aortic arch and intracranial vascular examination for 1 week.The intracranial magnetic resonance imaging(MRI)examination is performed in 1 week,and the clinical symptoms and signs were combined to diagnose the TIA in the patients with cerebral infarction within 1 week.The incidence of cerebral infarction in TIA patients with different arterial stenosis degree was analyzed and compared with the probability of cerebral infarction in patients with or without TIA history,and the incidence of cerebral infarction in patients with different vascular stenosis in patients with TIA history was compared.The incidence of cerebral infarction in patients with TIA history was compared with that of patients with ABCD~2 score of more than 4.SPSS17.0 statistical software was used to analyze all the related research data in this paper.The enumeration data described by percentage or rate(%)are used?2 test,correlation analysis using Pearson method,and measured data with mean number+standard deviation((?)�S)and t test analysis of normal distribution.The difference is statistically significant,(P<0.05).ResultsAmong the 156 cases of TIA,the number of patients with low,medium and high risk was 49,76 and 31 respectively.25%of the patients had cerebral infarction in 1weeks.The incidence of cerebral infarction was 8.1%(4/49),26.3%(20/76),48.4%(15/31)respectively.Results of comparison between groups was p<0.05.There was a positive correlation(r=0.652,P<0.05);the incidence of cerebral infarction in patients with severe arterial stenosis in 1 week was 45.7%(16/35)in the patients with ABCD~2score of more than 4,which was significantly higher than 19.2%(5/26)of normal and mild patients(5/26),P=0.031;the incidence of cerebral infarction in TIA patients with a history of TIA was 41.4%(24/58)in 1 week,higher than no TIA disease.The22.7%of the history group(10/44),P=0.047.Conclusions1.ABCD~2 score in TIA within 1 week of cerebral infarction has good clinical value,and the incidence of cerebral infarction is positively correlated with the ABCD~2 score of TIA.2.In patients with ABCD~2 score of more than 4,the incidence of cerebral infarction within 1 weeks of severe vascular stenosis is significantly higher than that of normal or mild arterial stenosis.ABCD~2 combined vascular examination can betterly predict the risk of cerebral infarction in 1 week of TIA patients and improve the accuracy of evaluation and prediction.3.Among the patients with ABCD~2 score or more than 4,the incidence of cerebral infarction in 7 days with TIA in 1 week was significantly higher than that in the no TIA group.ABCD~2 combined with TIA could betterly predict the risk of cerebral infarction within 1 week of the patients with TIA and improve the accuracy of the assessment.