ABSTRACT NUMBER: ESOC2026A2427 ABCD2 SCORE MAY NOT BE A RELIABLE STROKE PREDICTOR IN TIA PATIENTS WITH SEVERE INTRACRANIAL STENOSIS, A CASE SERIES

Abstract Background and aims The ABCD2 score was developed to assess patients after a transient ischemic attack (TIA) to identify those at high risk for TIA recurrence or stroke. However, the score is a clinical scale that does not incorporate vascular imaging. This is critical, as intracranial atherosclerotic disease (ICAD) is an independent predictor of stroke. Methods We retrospectively performed a review of collected data on all consecutive patients presenting to our stroke center between July 2024 and June 2025, who presented with their first-time stroke and experienced TIA before their stroke. Stroke should be attributed to angiographically verified significant stenosis of an intracranial artery. Results We found 16 patients presented with TIA, and in 9 cases it resolved before arrival; in the other 7 cases, it resolved upon arrival and before treatment began. All initial imaging was negative for any recent infarction. Their TIA symptoms were assessed using the ABCD2 score; all our patients received initial loading aspirin 300 mg and clopidogrel 300 mg. As all patients had an ABCD2 score of 2-3, which is considered low, the decision was to discharge them home and complete their workup in the outpatient clinic. Conclusions ICAD is the most common stroke subtype associated with a high risk of recurrence and has high prevalence in specific populations, such as South Asians. 1 in 5 patients with a low-risk ABCD2 score has symptomatic stenotic lesions, indicating the ABCD2 score does not identify all patients with symptomatic stenotic lesions. Prompt, accurate management of TIA in patients having ICAD is highly warranted. Conflict of interest Nothing to disclose