Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jan;56(1):56-64.
doi: 10.1161/STROKEAHA.124.048222. Epub 2024 Dec 5.

Short- and Long-Term Prognoses After Tissue-Negative Transient Ischemic Attack

Francisco Purroy  1   2 , Yhovany Gallego  1   2 , M Pilar Gil-Villar  1   2 , Robert Begue  3 , Gloria Arque  2 , Alejandro Quilez  1   2 , Jordi Sanahuja  1   2 , Daniel Vazquez-Justes  1   2 , Gerard Mauri  1   2
Affiliations

Short- and Long-Term Prognoses After Tissue-Negative Transient Ischemic Attack

Francisco Purroy et al. Stroke. 2025 Jan.

Abstract

Background: The tissue-based definition of transient ischemic attack, which requires the use of diffusion-weighted imaging (DWI), has limitations in its applicability to clinical practice. This contributes to the limited evidence regarding the risk of subsequent stroke and the associated predictors in the group of patients who are tissue-negative on DWI. Our aim was to assess the early and long-term prognoses of consecutive patients with tissue-negative transient ischemic attacks attended at an emergency department.

Methods: We performed a prospective cohort study of consecutive patients with neurologist-confirmed transient ischemic attack who were DWI-negative from January 2006 to June 2010. All patients underwent DWI on magnetic resonance imaging (4.0 [SD, 1.8] days) after the index event. The risk and predictors of stroke recurrence (SR) were determined at 1 year and after a median follow-up time of 6.6 (interquartile range, 5.0-9.6) years.

Results: A total of 370 patients were included. Previously, 244 patients with positive DWI results and 109 patients without magnetic resonance imaging performed were excluded. ABCD2 score >5 was determined in 95 (26.2%) patients; 15 (4.1%) patients experienced SR at 1 year and 18 (4.9%) beyond 1 year. Predictive models for short- and long-term prognoses were different. Large artery atherosclerosis cause (hazard ratio, 3.7 [95% CI, 1.2-11.0]) was the only predictor of 1-year SR. In contrast, male sex (hazard ratio, 4.17 [95% CI, 1.14-15.23]; P=0.031), speech impairment (hazard ratio, 4.90 [95% CI, 1.05-22.93]; P=0.044), and the presence of chronic microangiopathy expressed as Fazekas score of 3 (hazard ratio, 1.84 [95% CI, 1.15-2.97]; P=0.012) were predictors of long-term SR follow-up.

Conclusions: Patients with DWI-negative have a clinically important risk of recurrent vascular events and SR during medium- and long-term follow-ups. These patients warrant optimized secondary prevention to reduce their risk of recurrent vascular events over time. Predictors of SR varied over the follow-up.

Keywords: etiology; ischemic attack, transient; prognosis; white matter hyperintensities.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest regarding research, authorship, and the publication of this article. In preparing this article, we utilized the artificial intelligence tool ChatGPT, developed by OpenAI, solely for enhancing the English language expression. This assistance was confined to linguistic and grammatical aspects, with no impact on the scientific content, data interpretation, or study conclusions.

References

Publication types