Hypoperfusion Distal to Anterior Circulation Intracranial Atherosclerosis is Associated with Recurrent Stroke
Adam de Havenon1, Pooja Khatri2, Shyam Prabhakaran3
1Department of Neurology, University of Utah, Salt Lake City, UT.
Insights
Distal hypoperfusion in symptomatic intracranial atherosclerotic disease (ICAD) predicts recurrent stroke. This finding may help identify high-risk patients for future stroke prevention trials.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Symptomatic intracranial atherosclerotic disease (ICAD) poses a significant stroke risk.
- Impaired distal flow is a known stroke predictor in vertebrobasilar ICAD.
- Data on perfusion status and stroke recurrence in anterior circulation ICAD are limited.
Purpose of the Study:
- To investigate the association between distal hypoperfusion and recurrent stroke in patients with symptomatic anterior circulation ICAD.
- To evaluate the predictive value of perfusion status for stroke recurrence in this patient group.
Main Methods:
- Retrospective study of patients with 50-99% stenosis of the intracranial carotid or middle cerebral artery.
- Primary outcome: recurrent symptomatic ischemic stroke within 90 days.
- Primary predictor: distal hypoperfusion (≥15 mL volume with Tmax >6 seconds) on MR/CT perfusion imaging.
Main Results:
- Fifteen of 50 patients (30%) experienced recurrent stroke.
- Distal hypoperfusion was present in 66.7% of patients with recurrent stroke vs. 14.3% without (P < .001).
- Distal hypoperfusion significantly increased the hazard ratio for recurrent stroke (6.80; 95% CI 2.31-20.0).
Conclusions:
- Distal hypoperfusion is strongly associated with stroke recurrence in acutely symptomatic ICAD.
- Perfusion status may identify ICAD patients at higher risk for recurrent stroke.
- Distal hypoperfusion could be used to enrich patient selection for secondary stroke prevention trials in ICAD.
Background And Purpose:
In patients with symptomatic vertebrobasilar intracranial atherosclerotic disease (ICAD), impaired distal flow predicts recurrent stroke, but limited data exist on the association between perfusion status and recurrent stroke in anterior circulation ICAD.
Methods:
This is a retrospective study of patients hospitalized for symptomatic ICAD with 50-99% stenosis of the intracranial carotid or middle cerebral artery. The primary outcome is recurrent symptomatic ischemic stroke in the territory of the artery with ≥50% stenosis within 90 days. The primary predictor is distal hypoperfusion on magnetic resonance (MR) or computed tomography (CT) perfusion, defined as a ≥15 mL volume of territory of the symptomatic artery with Tmax >6 seconds.
Results:
Fifty patients met inclusion criteria, including 15 (30%) with recurrent stroke and 15 (30%) with distal hypoperfusion. Distal hypoperfusion was present in 10 of 15 (66.7%) with recurrent stroke versus 5 of 35 (14.3%) without recurrent stroke (P < .001). The hazard ratio for recurrent stroke in patients with distal hypoperfusion was 6.80 (95% confidence interval [CI] 2.31-20.0).
Conclusion:
Distal hypoperfusion in acutely symptomatic ICAD with 50-99% stenosis is associated with stroke recurrence. Distal hypoperfusion could be used to enrich future trials of secondary stroke prevention in ICAD patients.
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