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Multicenter Study
. 2025 Apr;20(4):426-437.
doi: 10.1177/17474930241302691. Epub 2024 Dec 16.

Transient brain ischemic symptoms and the presence of ischemic lesions at neuroimaging: Results from the READAPT study

Raffaele Ornello  1 , Matteo Foschi  1 , Federico De Santis  1 , Michele Romoli  2 , Tiziana Tassinari  3 , Valentina Saia  3 , Silvia Cenciarelli  4 , Chiara Bedetti  4 , Chiara Padiglioni  4 , Bruno Censori  5 , Valentina Puglisi  5 , Luisa Vinciguerra  5 , Maria Guarino  6 , Valentina Barone  6 , Maria Luisa Zedde  7 , Ilaria Grisendi  7 , Marina Diomedi  8 , Maria Rosaria Bagnato  8 , Marco Petruzzellis  9 , Domenico Maria Mezzapesa  9 , Pietro Di Viesti  10 , Vincenzo Inchingolo  10 , Manuel Cappellari  11 , Mara Zenorini  11 , Paolo Candelaresi  12 , Vincenzo Andreone  12 , Giuseppe Rinaldi  13 , Alessandra Bavaro  13 , Anna Cavallini  14 , Stefan Moraru  14 , Pietro Querzani  15 , Valeria Terruso  16 , Marina Mannino  16 , Umberto Scoditti  17 , Alessandro Pezzini  18 , Giovanni Frisullo  19 , Francesco Muscia  20 , Maurizio Paciaroni  21 , Maria Giulia Mosconi  21 , Andrea Zini  22 , Ruggiero Leone  23 , Carmela Palmieri  24 , Letizia Maria Cupini  25 , Michela Marcon  26 , Rossana Tassi  27 , Enzo Sanzaro  28 , Cristina Paci  29 , Giovanna Viticchi  30 , Daniele Orsucci  31 , Anne Falcou  32 , Susanna Diamanti  33 , Roberto Tarletti  34 , Patrizia Nencini  35 , Eugenia Rota  36 , Federica Nicoletta Sepe  37 , Delfina Ferrandi  37 , Luigi Caputi  38 , Gino Volpi  39 , Salvatore La Spada  40 , Mario Beccia  41 , Claudia Rinaldi  42 , Vincenzo Mastrangelo  42 , Francesco Di Blasio  43 , Paolo Invernizzi  44 , Giuseppe Pelliccioni  45 , Maria Vittoria De Angelis  43   46 , Laura Bonanni  47 , Giampietro Ruzza  48 , Emanuele Alessandro Caggia  49 , Monia Russo  50 , Agnese Tonon  51 , Maria Cristina Acciarri  52 , Sabrina Anticoli  53 , Cinzia Roberti  54 , Giovanni Manobianca  55 , Gaspare Scaglione  55 , Francesca Pistoia  1 , Alberto Fortini  56 , Antonella De Boni  57 , Alessandra Sanna  58 , Alberto Chiti  59 , Leonardo Barbarini  60 , Maela Masato  61 , Massimo Del Sette  62 , Francesco Passarelli  63 , Maria Roberta Bongioanni  64 , Danilo Toni  65 , Stefano Ricci  4   66 , Simona Sacco  1 , Eleonora De Matteis  67
Affiliations
Multicenter Study

Transient brain ischemic symptoms and the presence of ischemic lesions at neuroimaging: Results from the READAPT study

Raffaele Ornello et al. Int J Stroke. 2025 Apr.

Abstract

Background: According to the literature, about one third of patients with brain ischemic symptoms lasting <24 h, which are classified as Transient ischemic attacks (TIAs) according to the traditional "time-based" definition, show the presence of acute ischemic lesions at neuroimaging. Recent evidence has shown that the presence of acute ischemic lesions at neuroimaging may impact on the outcome of patients with transient ischemic symptoms treated with dual antiplatelet treatment (DAPT). This uncertainty is even more compelling in recent years as short-term DAPT has become the standard treatment for any non-cardioembolic TIA or minor ischemic stroke.

Methods: This is a pre-specified subgroup analysis from a prospective multicenter real-world study (READAPT). The analysis included patients with time-based TIA-that is, those with ischemic symptoms lasting <24 h-who started DAPT. In the whole population, we assessed the presence of acute brain ischemic lesions at neuroimaging and their association with the ABCD2 score. To assess the impact of acute brain ischemic lesions on 90-day prognosis, we performed a propensity score matching of patients with and without those lesions. We adopted a primary effectiveness outcome which was a composite of new stroke/TIA events and death due to vascular causes at 90 days.

Results: We included 517 patients-324 (62.7%) male-with a median (interquartile range-IQR) age of 74 (IQR = 65-81) years; 144 patients (27.9%) had acute brain ischemic lesions at neuroimaging. The proportion of patients with brain ischemic lesions did not vary according to the ABCD2 score. At follow-up, 4 patients with brain ischemic lesions (2.8%) and 21 patients without lesions (5.6%) reported the primary effectiveness outcome, which was similar between the groups before (p = 0.178) and after matching (p = 0.518).

Conclusions: In our population, patients with transient ischemic symptoms and acute ischemic lesions at brain magnetic resonance imaging (MRI) had a risk of recurrent ischemic events similar to those without lesions. The risk of recurrent ischemic events was low in both groups.

Keywords: Transient ischemic attack; brain ischemia; dual antiplatelet therapy; ischemic lesions; neuroimaging; outcomes.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: A.Z. reports compensation from Angels Initiative, Boehringer-Ingelheim, and Daiichi Sankyo for consultant services; from Angels Initiative, Boehringer-Ingelheim, and CSL Behring for speaking honoraria or other education services; from Daiichi Sankyo for meeting; from Bayer and Astra Zeneca for participation on a Data Safety, Monitoring Board or Advisory Board; and he is member of ESO guidelines, ISA-AII guidelines, and IRETAS steering committee. R.O. reports grants from Novartis and Allergan; compensation from Teva Pharmaceutical Industries, Eli Lilly and Company, and Novartis for other services; and travel support from Teva Pharmaceutical Industries. S.S. reports compensation from Novartis, NovoNordisk, Allergan, AstraZeneca, Pfizer Canada, Inc., Eli Lilly and Company, Teva Pharmaceutical Industries, H. Lundbeck A/S, and Abbott Canada for consultant services; employment by Università degli Studi dell’Aquila; and compensation from Novartis for other services. MP reports compensation from Daiichi Sankyo Company, Bristol Myers Squibb, Bayer, and Pfizer Canada, Inc., for consultant services. DT reports compensation from Alexion, Astra Zeneca, Medtronic, and Pfizer for consultant services and participation on a Data Safety, Monitoring Board or Advisory Board. The other authors report no conflicts.

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