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Silent new ischemic lesions after index stroke and the risk of future clinical recurrent stroke

Dong-Wha Kang1, Moon-Ku Han2, Hye-Jin Kim2

  • 1From the Department of Neurology (D.-W.K., H.-J.K., H.S., B.J.K., S.U.K., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul; Department of Neurology (M.-K.H.), Seoul National University Bundang Hospital, Seongnam, South Korea; and Department of Neurology (S.W.), Dell Medical School University of Texas at Austin. dwkang@amc.seoul.kr.

Neurology
|December 20, 2015
PubMed
Abstract

Insights

Silent new ischemic lesions (SNIL) detected by MRI within weeks of a stroke predict future strokes and vascular events. This finding aids in identifying high-risk patients for secondary prevention.

Area of Science:

  • Neurology
  • Radiology
  • Cardiology

Background:

  • Silent new ischemic lesions (SNIL) on MRI are increasingly recognized post-stroke.
  • The predictive value of early SNIL for future vascular events requires further investigation.

Purpose of the Study:

  • To determine if SNIL identified on MRI within the first month after an ischemic stroke predicts recurrent ischemic stroke or other vascular events.
  • To assess SNIL as a potential surrogate endpoint in secondary stroke prevention trials.

Main Methods:

  • Prospective study of acute ischemic stroke patients undergoing serial MRI (baseline, 5 days, 30 days).
  • SNIL presence assessed using diffusion-weighted and FLAIR imaging.
  • Patients followed for 5 years for recurrent ischemic stroke and major vascular events; statistical analysis using log-rank test and Cox models.

Main Results:

  • SNIL were detected in 24.4% at 5 days (5D-SNIL) and 7.4% at 30 days (30D-SNIL).
  • During 5-year follow-up, 15.6% of patients experienced clinical events.
  • Both 5D-SNIL and 30D-SNIL independently predicted recurrent ischemic stroke and composite vascular events, with higher hazard ratios for 30D-SNIL.

Conclusions:

  • Patients with SNIL in the early weeks post-stroke face a significantly higher risk of recurrent ischemic stroke and vascular events.
  • Early SNIL detection on MRI can serve as a valuable surrogate endpoint for clinical recurrence in secondary prevention trials.

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