Transient Ischemic Attack Fast-track and Long-Term Stroke Risk: Role of Diffusion-Weighted Magnetic Resonance Imaging Sabrina Anticoli, MD,* Francesca Romana Pezzella, MD,* Claudio Pozzessere, MD,* Luca Gallelli, MD,† Maria Cristina Bravi, MD,‡ Valeria Caso, MD,x and Antonio Siniscalchi, MDjj Background: Acute ischemic lesions on diffusion-weighted magnetic resonance imaging (DWI-MRI) are reliable predictors of recurrent stroke at 90 days. However, to date, limited information on transient ischemic attack (TIA) patients with positive DWI lesions for stroke risk from 1 to 5 years is available. In this study, we evaluated the role of positive DWI lesions and vascular risk factors on stroke, cardiovascular death, and mortality at 90 days (T0), 1 year (T1), and 5 years (T2). Moreover, we also evaluated the association between stroke risk and the presence of DWI lesions. Methods: We performed an observational study on consecutive patients admitted to the emergency department of San Camillo-Forlanini Hospital, Rome, Italy, from January 2007 to November 2012. Over the study period, 4300 patients with TIA or ischemic stroke were examined by stroke specialists in an emergency room setting within 1 hour from admittance. Results: In 510 of 4300 patients (11.86%), a TIA was diagnosed, and 445 patients satisfy the study inclusion criteria. For all 445 patients, the mean ABCD2 score was 4.35 6 1.30. Using DWI-MRI, we identified acute ischemic lesions in 185 patients (41.57%). We did not observe any correlation between duration of symptoms, ABCD2 score, and positive or negative DWI lesions. Positivity for DWI was not associated with the presence of diabetes mellitus, hyper- tension, smoking habit, or age; however, an association with weakness was observed. We documented a time-dependent increase in the absolute risk of stroke: T0: 1.35% (95% confidence interval [CI], .81-2.8); T1: 4.78% (95% CI, 2.88-7.47); T2: 9.02% (95% CI, 4.66-5.70). We did not record any difference in stroke risk in patients with positive DWI lesions: T0: hazard ratio [HR], 1.43; 95% CI, .35-5.88; log-rank P 5 .60; T1: HR, 1.04; 95%CI, .42-2.61; log-rank P 5 .91; T2: HR, .83; 95% CI, .25-2.67; log-rank P 5 .86. Conclusions: This long-term follow-up study in TIA patients documents that both positive and negative DWI patients treated with fast-track had similar long-term risks of stroke. Key Words: TIA—ischemic stroke—DWI-MRI—stroke. Ó 2015 by National Stroke Association From the *Stroke Unit, San Camillo Forlanini Hospital, Rome; †Department of Experimental and Clinical Medicine, School of Med- icine, University Magna Graecia of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital, Catanzaro; ‡Department of Internal Medicine, San Camillo Forlanini Hospital, Rome; xStroke Unit and Division of Cardiovascular Medicine, University of Perugia Santa Maria della Misericordia Hospital, Perugia; and jjDepartment of Neurology, Annunziata Hospital, Cosenza, Italy. Received January 22, 2015; revision received April 23, 2015; accepted May 17, 2015. F.R.P. received honoraria as a member of the speaker bureau of Boehringer Ingelheim. V.C. received honoraria as a member of the speaker bureau of Boehringer Ingelheim and Bayer. All the other authors have no relevant conflicts of interest. The authors have not received funding for their research. Address correspondence to Antonio Siniscalchi, MD, Department of Neurology, Annunziata Hospital, Via F. Migliori, 1, 87100 Cosenza, Italy. E-mail: anto.siniscalchi@libero.it. 1052-3057/$ - see front matter Ó 2015 by National Stroke Association http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2015.05.016 Journal of Stroke and Cerebrovascular Diseases, Vol. -, No. - (---), 2015: pp 1-7 1