Predictors and outcomes of ischemic stroke in reversible cerebral vasoconstriction syndrome

The clinical factors predisposing to ischemic stroke in reversible cerebral vasoconstriction syndrome (RCVS) are unclear. In this observational cross-sectional study, we aimed to evaluate the risk factors and clinical outcomes associated with the development of ischemic stroke in patients with RCVS.

We utilized the Nationwide Readmissions Database 2016-2017 to identify all hospitalizations with RCVS, with or without acute ischemic stroke. Independent predictors of and clinical outcomes associated with ischemic stroke were analyzed using logistic regression.

Among 1065 hospitalizations for RCVS (mean ± SD age 49.0 ± 16.7 years, female 69.7%), 267 (25.1%) had ischemic stroke. Patients with ischemic stroke were more likely to have hypertension (OR 2.33, 95% CI 1.51-3.60), diabetes (OR 1.81, 95% CI 1.11-2.98), and tobacco use (OR 1.64, 95% CI 1.16-2.33) and were less likely to have a history of migraine (OR 0.56, 95% CI 0.35-0.90). Ischemic stroke was associated with higher odds of cerebral edema (OR 3.15, 95% CI 1.31-7.57) and respiratory failure (OR 2.39, 95% CI 1.28-4.44). Patients with ischemic stroke also had longer hospital stay by a mean duration of 6.7 days, P < 0.001, higher hospital charges by a mean of $72,961, P < 0.001, and a higher likelihood of not being discharged to home (OR 3.57, 95% CI 2.39-5.33). They had higher in-hospital mortality rate; however, the difference was not statistically significant.

Ischemic stroke affects nearly 25% of patients with RCVS and is associated with adverse clinical outcomes. RCVS patients with cerebrovascular risk factors might have a higher predisposition for developing ischemic lesions during the disease process.