Neurological Deficit and Cerebral Hemodynamic Characteristics in Patients with Carotid Territory Ischemic Stroke According to Previous Transient Ischemic Attacks
Keywords:
Carotid territory ischemic stroke, transient ischemic attack, cerebral hemodynamicsAbstract
Background: Previous transient ischemic attacks (TIAs) are considered an important predictor of subsequent ischemic stroke and may influence the severity of neurological impairment through alterations in cerebral hemodynamics. However, their impact on neurological deficits and vascular reactivity during the acute phase of carotid territory ischemic stroke remains insufficiently characterized.
Objective: To evaluate the association between previous transient ischemic attacks and neurological status, cerebral blood flow parameters, and vascular reactivity in patients with first-ever carotid territory ischemic stroke.
Methods: This prospective observational study included 74 patients admitted with first-ever acute carotid territory ischemic stroke. Patients were divided into two groups according to the presence (n = 40) or absence (n = 34) of previous TIAs. A control group comprised 20 age- and sex-matched healthy individuals. Neurological severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), the modified Rankin Scale (mRS), and the Rivermead Mobility Index (RMI). Cerebral hemodynamics were evaluated by duplex ultrasonography of the brachiocephalic arteries with functional compression testing. Statistical analysis was performed using Student's t-test, with p < 0.05 considered statistically significant.
Results: Patients with previous TIAs demonstrated significantly greater neurological impairment than those without TIAs. The mean NIHSS score was 12.3 ± 3.6 versus 10.5 ± 4.1 (p = 0.023), while the mean mRS score was 3.7 ± 1.4 versus 2.4 ± 1.7 (p = 0.015). Functional mobility was significantly lower in patients with previous TIAs (RMI: 10.3 ± 2.6 vs. 12.3 ± 3.2; p = 0.032). Duplex ultrasonography revealed significantly reduced post-compression blood flow velocity in the common carotid artery among patients with previous TIAs (42.3 ± 8.1 cm/s vs. 50.5 ± 10.2 cm/s; p < 0.01). These patients also exhibited impaired vascular reactivity, reduced arterial elasticity, increased peripheral vascular resistance, and delayed recovery following compression, indicating diminished cerebrovascular reserve.
Conclusion: A history of transient ischemic attacks is associated with more severe neurological deficits and impaired cerebral hemodynamics in patients with first-ever carotid territory ischemic stroke. Previous TIAs appear to reflect progressive cerebrovascular dysfunction rather than a protective ischemic preconditioning effect. Assessment of cerebral blood flow and vascular reactivity may improve early prognostic evaluation and support individualized therapeutic and secondary prevention strategies.
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