Recurrent stroke risk in intracranial atherosclerotic disease
Ahmad A Ballout1, David S Liebeskind2
1Department of Neurology, Northwell Health, and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, United States.
Insights
Biomarkers indicating hemodynamic issues and embolization risk significantly predict recurrent stroke in intracranial atherosclerotic disease. Future trials should incorporate these markers for better patient stratification and individualized treatment decisions.
Area of Science:
- Neurology
- Vascular Neurology
- Stroke Medicine
Background:
- Intracranial atherosclerotic disease (ICAD) poses a high risk for recurrent stroke, even with optimal medical management.
- Biomarkers related to hemodynamic insufficiency and embolization potential are independently and synergistically associated with increased stroke recurrence.
- Current treatment trials often prioritize luminal stenosis, limiting the investigation of hemodynamic factors in primary analyses.
Purpose of the Study:
- To review and synthesize existing research on biomarkers for predicting recurrent stroke risk in patients with ICAD.
- To highlight the importance of hemodynamic and embolic biomarkers in understanding and managing ICAD.
- To inform future clinical trial design and patient risk stratification strategies.
Main Methods:
- Systematic review of studies investigating biomarkers and recurrent stroke risk in ICAD.
- Analysis of evidence linking hemodynamic insufficiency and embolization markers to stroke recurrence.
- Evaluation of the role of these biomarkers in existing clinical trial criteria and natural history studies.
Main Results:
- Biomarkers of hemodynamic compromise and embolic events are strong predictors of recurrent stroke in ICAD.
- The synergistic effect of these biomarkers amplifies stroke recurrence risk.
- Current trial designs may underestimate the predictive value of these biomarkers due to focus on luminal stenosis.
Conclusions:
- Incorporating hemodynamic and embolic biomarkers into future ICAD trials is crucial for accurate risk assessment.
- Stratifying patients based on these high-risk biomarkers can lead to more personalized clinical decision-making.
- Further research and trial adaptation are needed to fully leverage these biomarkers for stroke prevention.
Abstract:
Recurrent stroke risk secondary to intracranial atherosclerotic disease remains high despite aggressive medical treatment. This risk is further amplified in subgroups possessing biomarkers of hemodynamic insufficiency and potential for embolization, which have been shown to be independently and synergistically predictive of recurrent stroke. Luminal stenosis was predominantly used as entry criteria in major treatment trials, discounting the potential role of hemodynamics from primary analyses, limiting the strength of evidence and conclusions of these biomarkers to post-hoc analyses and other natural history studies. Future treatment trials should consider stratifying patients using a combination of these high-risk biomarkers. In the absence of trials, risk stratifying patients based on the presence of these markers may lend to more individualized clinical decisions. We aimed to summarize the studies that have investigated the relationship between biomarkers and their role in predicting recurrent stroke risk in intracranial atherosclerotic disease.
Related Concept Videos
01:26Arteries of the Head and Neck
The internal carotid arteries supply blood to the anterior portion of the cerebrum. They enter the...
01:23Atherosclerosis IV: Nursing Management
01:10The Arch of Aorta
Encircling the heart, the coronary arteries form a ring-like structure before...
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...