Objective To evaluate the association of magnetic resonance angiography (MRA),diffusion-weighted imaging (DWI) and the ABCD2 score assessments with secondary cerebral infarction after transient ischemic attack (TIA).Methods Intracranial vascular MRA,cranial DWI and ABCD2 score were retrospectively analyzed in 162 cases with TIA.The impact of TIA on survival time was assessed using the univariate Kaplan-Meier curve by Log-rank test.Hazard ratio (HR) and 95 ％ confidence interval (CI) of secondary cerebral infarction after TIA predicted by MRA,DWI and ABCD2 score were analyzed by Cox multivariable regression.Results Among the 162 patients with first attack of TIA,86 cases (53.1 ％) developed cerebral infarction within 90 d,of which 22 cases (13.6％) developed secondary cerebral infarction within 0 7 d,27 cases (16.7％) within 8～30d and 37 cases (22.8％) within 31-90 d.Single factor analysis by Kaplan-Meier curve showed that moderate to severe intracranial vascular stenosis diagnosed by MRA,positive DWI and moderate to high ABCD2 score were obviously related to cerebral infarction after first attack of TIA (all P＜0.001 or 0.01).Cox multifactor risk model indicated that age ≥70 y,moderate to severe intracranial vascular stenosis,positive DWI,moderate to high ABCD2 score were the risk factors for secondary cerebral infarction within 90 d after TIA (HR=1.782,2.245,1.964,1.204,95％CI:1.171-2.256,1.627 3.097,1.273-3.031,1.050-1.381,respectively,P＜0.05,0.01 or 0.001).Conclusions Intracranial artery stenosis examination may be more valuable than DWI and ABCD2 score in evaluating the outcome of TIA.

Objective To investigate the effects of changes of miR-126 and spouty related EVH,domain containing proteinl(SPRED1) after transient ischemic attack(TIA)on prognostic value for pathogenesis of secondary cerebral infarction.Methods Retrospective analysis of the clinical data of 106 patients with TIA was performed.The expression levels of miR-126,SPRED1 and vascular endothelial growth factor(VEGF)in peripheral blood were detected at 3 h,6 h and 12 h after TIA onset respectively.The specificity and sensitivity of miR 126 and SPRED1 in the diagnosis of TIA were analyzed.The miR-126 and SPRED1 levels versus ABCD2 score were compared for evaluating their predictive value in the diagnosis of secondary cerebral infarction within 30 days after TIA onset.Results The miR-126 level was declined after TIA onset at 3 h(9.41±1.04),especially at 12 h(6.59 ±2.78),versus in healthy control (9.35±1.76)(t =-7.764,P=0.000).The SPRED1 level after TIA onset was increased at 3 h(58.05 ± 17.53)pg/L,12 h(82.64 ± 18.60)pg/L versus in healthy control(52.38 ± 13.24)pg/L(t=12.374,P =0.000).A closely negative correlation was found between levels of miR 126 and SPRED1 at 12 h point but not at 3 h and 6 h(r=-0.278,P=0.004).Both miR-126 and SPRED1 levels at 12 h after TIA were implied to sensitivity and specificity evaluation.Additionally,VEGF was significantly increased at 3 h (345.61 ± 76.76) pg/L,6 h (461.65 ±103.87)pg/L and 12 h (519.22 ± 103.55)pg/L after TIA onset as compared with healthy control (107.77± 26.04) pg/L(t =26.569,29.756,34.699,all P =0.000).The decrease of miR-126 and increase of SPRED1 at 12h after TIA indicated high incidences of cerebral infarction but their significance was less than ABCD2 score.Combination of miR 126,SPRED1 and ABCD2 score significantly improved the prediction for cerebral infarction(Z=2.105,P =0.035).Conclusions After the onset of TIA,levels of miR-126 and SPRED1 expression in combination of ABCD2 score can improve predictive value for cerebral infarction development.

Objective To predict a value of ischemia modified albumin (IMA) levels for assessing secondary cerebral infarction in patients with transient ischemic attack (TIA) in anterior circulation.Methods 105 patients with TIA in anterior circulation admitted to the hospital within 3 hours were retrospectively studied.Combined with ABCD2 score,the correlations of IMA levels at 3 h,6 h and 12 h with secondary cerebral infarction after anterior circulation TIA were analyzed.Results IMA level was 75.28 u/L within 3h after TIA,and the sensitivity and specificity of TIA in anterior circulation were 66.7％ and 76.2％ respectively.In the total of 105 patients,16 cases (15.2％) suffered from secondary cerebral infarction within 7d,and 21 cases (20.0％) within 8～30d.The serum IMA levels were (87.43±19.89)U/L,(63.88±12.51)U/L and (61.21±12.28)U/L at 3h,6h and 12h after TIA,respectively.A simple analysis showed that there was a linear correlation between the IMA level and ABCD2 scores (P=0.000,r=0.666).Kaplan-Meier survival curve analysis showed that the increased IMA level within 3h,and moderate to high ABCD2 score were the risk factors for secondary cerebral infarction after TIA in anterior circulation (P=0.012,0.041).Conclusions Early detection of IMA has a clinical value similar to ABCD2 score to predict secondary cerebral infarction in patients with TIA in anterior circulation.

Objective: To evaluate the efficacy and safety of intravenous thrombolysis with recombinant tissue-plasminogen activator (rt-PA) in elderly patients with early-stage mild ischemic stroke (IS). Methods: This was a prospective, open-label, controlled study.Ninety-four elderly patients with mild IS admitted to our hospital from January 2014 to December 2017 were randomized into a thrombolysis arm (TA, n=46) and a control arm (CA, n=48). The short-term endpoints were the National Institutes of Health stroke scale (NIHSS) scores on 3^rd, 7^th, 14^thday after admission and the secondary endpoints were the modified Rankin Scale (mRS) score and the morbidity of recurrence IS within 90 days.Safety was evaluated by the incidence of intracranial hemorrhage (IH) and early neurological deterioration (END) during hospitalization. Results: The baseline NIHSS scores of patients in the TA and CA groups were similar [(4.1±0.7) vs.(4.1±0.7)]. However, there were significant differences in the NIHSS score on 3^rd [(3.4±1.2) vs.(4.2±1.4)], 7^th[(3.0±1.8) vs.(4.1±1.6)] and 14^thday [(2.5±2.0) vs.(3.4±1.6)], respectively, between the TA group and the CA group.Furthermore, the TA group was associated with a significantly higher proportion of patients with good prognosis (mRS, 0-2), compared with the CA group (71.7% vs.35.4%, P<0.01). Receiver operating characteristic curve analysis showed that patients with baseline NIHSS>3 could benefit from thrombolytic therapy.There were 1 case of symptomatic IH and 1 case of progressive stroke in the TA group, and 1 case of IH and 2 cases of progressive stroke in the control group.There were no significant differences in the rate of either END or IH between the two groups (P>0.05). Two patients in the TA group and three patients in the control group had recurrent IS within 90 days and the recurrence rate of IS was also similar within 90 days (P>0.05). Conclusions Intravenous thrombolytic therapy with rt-PA can improve the prognosis of elderly patients with mild stroke without increased risk of END, IH, or recurrence of IS.