Abstract 3932: High Rate Of Radiographic Stroke Recurrence In Cryptogenic TIA And Minor Stroke Patients: A Prospective Imaging Study
Notice bibliographique
Résumé
Introduction: Cryptogenic stroke (CS) mechanism in patients with TIA/Minor stroke has a recurrent stroke risk of 1-6% within 3 months. There is some evidence to suggest that an occult embolic phenomenon would be a likely cause of stroke in many patients with CS. It is likely that radiographic event rates are higher than clinical event rates which may potentially be a therapeutic target for proof of concept prevention trials. We sought to determine clinical and radiographic event rates in patients with cryptogenic mechanisms in a TIA/minor stroke population. Methods: Patients with TIA/Minor stroke (NIH Stroke Scale ≤ 3) were prospectively enrolled and imaged within 24 hours of symptom onset as part of two prospective imaging cohorts. [VISION (V) and CATCH (C)]. Patients were included if their baseline modified Rankin scale (mRS) was ≤1. All patients were followed clinically for 3 months to document any clinical recurrence and had a repeat MRI either at day 30 (V) or at day 90 (C). Stroke mechanisms were categorized as per TOAST criteria after parenchymal and vascular imaging and cardiac investigations. Patients were labelled as cryptogenic only after standard etiological workup for ischemic stroke including at least vascular imaging, transthoracic echocardiogram and holter monitoring was completed. Follow up imaging was assessed for any new lesions in comparison to baseline imaging. Results: Among patients enrolled in both prospective studies 380/844(45%) had cryptogenic stroke mechanisms. Of these, 215 patients had follow up imaging. There were 132 (61%) males. Intracranial occlusions was seen in 23/215 (10.6%) with baseline DWI abnormality documented in 66/215 (30.6%). In the VISION dataset, 5/76 (6.6%, 95%CI 2.2-15%) patients had new lesions on follow-up MRI at day 30. In the CATCH dataset 19/131 (14.5%: 9-22%) of patients had new lesions on follow-up MRI at day 90. Baseline DWI abnormalities was a significant predictor of new radiological lesions on follow-up imaging [p=0.003 OR 4.75 95% CI: 1.67-13.2]. Overall clinical recurrence was seen in 10/215 (4.6%: 2.2-8.4%) of patients. Baseline DWI abnormality was not a significant predictor of clinical recurrence (p=0.96). Conclusion: TIA/Minor stroke patients with cryptogenic mechanism show evidence of silent radiological accumulation of disease on follow up imaging at a higher rate than clinical recurrence. Repeat brain imaging at 3 months or potentially later may be a useful surrogate marker for disease activity in treatment trials in this population. There is a need for randomized controlled trials using novel anticoagulants with follow-up imaging as a surrogate marker of disease activity to improve treatment of cryptogenic minor stroke/TIA.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».