Background and Purpose: Craniocervical artery stenosis is an important etiology for transient ischemic attack (TIA). We hypothesized ABCD and ABCD2 scores can predict craniocervical artery stenosis in patients with TIA. Methods: ABCD and ABCD2 scores were calculated in a total of 479 consecutive first-ever TIA patients in Nanjing Stroke Registry Program and compared with angiographic imaging derived from MRI or invasive catheter-based angiography. Results: Overall craniocervical artery (O-CA) stenosis was found in 197 (41.1%) patients. Extracranial craniocervical artery (E-CA) and intracranial craniocervical artery (I-CA) stenosis was found in 101 (21.1%) and 110 (23%) cases, respectively. ABCD and ABCD2 scores with similar accuracy for O-CA (AUCABCD 0.71, AUCABCD2 0.70), E-CA (AUCABCD 0.72, AUCABCD2 0.72) and I-CA stenosis (AUCABCD 0.62, AUCABCD2 0.62) were both independent predictors for various categories of artery stenosis after being adjusted for non-ABCD2 parameters. The cut-off points were equally 4 in both predicting rules. For ABCD, sensitivity was 57.4, 65.3 and 52.7% and specificity 77.0, 70.4 and 67.5% for O-CA/E-CA/I-CA, respectively. For ABCD2, sensitivity was 61.9, 69.3 and 58.2% and specificity 72.3, 65.6 and 63.1%. Conclusions: In patients with TIA, despite an association between ABCD and ABCD2 scores and underlying craniocervical artery stenosis, the clinical utility was limited by unsatisfactory sensitivity and specificity.

Keywords:
Transient ischemic stroke, ABCD score, ABCD2 score, Craniocervical artery stenosis
1.
Rothwell PM, Giles MF, Flossmann E, Lovelock CE, Redgrave JN, Warlow CP, et al: A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack. Lancet 2005;366:29-36.
2.
Calvet D, Touze E, Oppenheim C, Turc G, Meder JF, Mas JL: DWI lesions and TIA etiology improve the prediction of stroke after TIA. Stroke 2009;40:187-192.
3.
Eliasziw M, Kennedy J, Hill MD, Buchan AM, Barnett HJ: Early risk of stroke after a transient ischemic attack in patients with internal carotid artery disease. CMAJ 2004;170:1105-1109.
4.
Meseguer E, Lavallee PC, Mazighi M, Labreuche J, Cabrejo L, Olivot JM, et al: Yield of systematic transcranial Doppler in patients with transient ischemic attack. Ann Neurol 2010;68:9-17.
5.
Kennedy J, Hill MD, Ryckborst KJ, Eliasziw M, Demchuk AM, Buchan AM: Fast assessment of stroke and transient ischaemic attack to prevent early recurrence (FASTER): a randomised controlled pilot trial. Lancet Neurol 2007;6:961-969.
6.
Lavallee PC, Meseguer E, Abboud H, Cabrejo L, Olivot JM, Simon O, et al: A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects. Lancet Neurol 2007;6:953-960.
7.
Rothwell PM, Eliasziw M, Gutnikov SA, Fox AJ, Taylor DW, Mayberg MR, et al: Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 2003;361:107-116.
8.
Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, et al: Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet 2007;369:283-292.
9.
Fothergill A, Christianson TJ, Brown RD Jr, Rabinstein AA: Validation and refinement of the ABCD2 score: a population-based analysis. Stroke 2009;40:2669-2673.
10.
Calvet D, Lamy C, Touze E, Oppenheim C, Meder JF, Mas JL: Management and outcome of patients with transient ischemic attack admitted to a stroke unit. Cerebrovasc Dis 2007;24:80-85.
11.
Schrock JW, Victor A, Losey T: Can the ABCD2 risk score predict positive diagnostic testing for emergency department patients admitted for transient ischemic attack? Stroke 2009;40:3202-3205.
12.
Koton S, Rothwell PM: Performance of the ABCD and ABCD2 scores in TIA patients with carotid stenosis and atrial fibrillation. Cerebrovasc Dis 2007;24:231-235.
13.
Liu X, Xu G, Wu W, Zhang R, Yin Q, Zhu W: Subtypes and one-year survival of first-ever stroke in Chinese patients: The Nanjing Stroke Registry. Cerebrovasc Dis 2006;22:130-136.
14.
Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Feldmann E, et al: Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing, and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke 2009;40:2276-2293.
15.
North American Symptomatic Carotid Endarterectomy Trial: Methods, patient characteristics, and progress. Stroke 1991;22:711-720.
16.
Prognosis of patients with symptomatic vertebral or basilar artery stenosis. The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) study group. Stroke 1998;29:1389-1392.
17.
Scarabino T, Carriero A, Giannatempo GM, Marano R, De Matthaeis P, Bonomo L, et al: Contrast-enhanced MR angiograph in the study of the carotid stenosis: comparison with digital subtraction angiography. J Neuroradiol 1999;26:87-91.
18.
Inzitari D, Eliasziw M, Gates P, Sharpe BL, Chan RK, Meldrum HE, et al: The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 2000;342:1693-1700.
19.
Mathiesen EB, Joakimsen O, Bonaa KH: Prevalence of and risk factors associated with carotid artery stenosis: The TROMSO Study. Cerebrovasc Dis 2001;12:44-51.
20.
Fan C, Huang Y: Prevalence of cerebral arterial stenosis in 2711 rural community people aged over 40 years in Beijing. Chin J Geriatr Heart Brain Vessel Dis 2007;9:36-38.
21.
Scott RM, Smith ER: Moyamoya disease and moyamoya syndrome. N Engl J Med 2009;360:1226-1237.
22.
Kuroda S, Houkin K: Moyamoya disease: current concepts and future perspectives. Lancet Neurol 2008;7:1056-1066.
23.
Zhang Y, Wu S, Jia Z, Zhou Y, Liu X, Wang W, et al: The relationship of asymptomatic intracranial artery stenosis and Framingham stroke risk profile in a northern Chinese industrial city. Neurol Res 2012;34:359-365.
24.
Khan A, Kasner SE, Lynn MJ, Chimowitz MI: Risk factors and outcome of patients with symptomatic intracranial stenosis presenting with lacunar stroke. Stroke 2012;43:1230-1233.
25.
Sheehan OC, Kyne L, Kelly LA, Hannon N, Marnane M, Merwick A, et al: Population-based study of ABCD2 score, carotid stenosis, and atrial fibrillation for early stroke prediction after transient ischemic attack: The North Dublin TIA Study. Stroke 2010;41:844-850.
26.
Serfaty JM, Chirossel P, Chevallier JM, Ecochard R, Froment JC, Douek PC: Accuracy of three-dimensional gadolinium-enhanced MR angiography in the assessment of extracranial carotid artery disease. AJR Am J Roentgenol 2000;175:455-463.
27.
Back MR, Wilson JS, Rushing G, Stordahl N, Linden C, Johnson BL, et al: Magnetic resonance angiography is an accurate imaging adjunct to duplex ultrasound scan in patient selection for carotid endarterectomy. J Vasc Surg 2000;32:429-440.
28.
Randoux B, Marro B, Koskas F, Duyme M, Sahel M, Zouaoui A, et al: Carotid artery stenosis: prospective comparison of CT, three-dimensional gadolinium-enhanced MR, and conventional angiography. Radiology 2001;220:179-185.
29.
Binaghi S, Maeder P, Uské A, Meuwly JY, Devuyst G, Meuli RA: Three-dimensional computed tomography angiography and magnetic resonance angiography of carotid bifurcation stenosis. Eur Neurol 2001;46:25-34.
30.
Scarabino T, Carriero A, Magarelli N, Florio F, Giannatempo GM, Bonomo L, et al: MR angiography in carotid stenosis: a comparison of three techniques. Eur J Radiol 1998;28:117-125.
31.
Nederkoorn PJ, van der Graaf Y, Hunink MG: Duplex ultrasound and magnetic resonance angiography compared with digital subtraction angiography in carotid artery stenosis: a systematic review. Stroke 2003;34:1324-1332.
32.
Gaa J, Weidauer S, Requardt M, Kiefer B, Lanfermann H, Zanella FE: Comparison of intracranial 3D-ToF-MRA with and without parallel acquisition techniques at 1.5 T and 3.0 T: preliminary results. Acta Radiol 2004;45:327-332.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.