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Updated: Jul 29, 2025
Author Spotlight: Assessing Ischemic Stroke Damage Through Middle Cerebral Artery Occlusion Model
Published on: August 11, 2023
Ischemic stroke recurrence and mortality in different imaging phenotypes of ischemic cerebrovascular disease: The
Carlo Lucci1, Ina Rissanen2, Pim A de Jong1
1Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
Insights
Patients with any imaging phenotype of cerebrovascular disease face higher risks of recurrent ischemic stroke and mortality. Early and strict preventive measures are crucial, even without clear clinical symptoms or imaging findings.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Medicine
Background:
- Cerebrovascular disease diagnosis relies on clinical and radiological findings, which may not always align.
- Understanding the prognostic implications of different imaging phenotypes is crucial for patient management.
Purpose of the Study:
- To investigate the risk of ischemic stroke recurrence and mortality in patients with various imaging phenotypes of cerebrovascular disease.
- To compare these risks across different patient groups within the SMART-MR study cohort.
Main Methods:
- Prospective cohort study (SMART-MR) classifying participants into four groups: no cerebrovascular disease, symptomatic cerebrovascular disease, covert vascular lesions, and imaging-negative ischemia.
- Follow-up for up to 17 years, recording ischemic strokes and deaths at 6-month intervals.
- Cox regression analysis adjusted for age, sex, and cardiovascular risk factors to assess associations between phenotype and outcomes.
Main Results:
- Increased risk of recurrent ischemic stroke was observed in symptomatic cerebrovascular disease (HR 3.9), covert vascular lesions (HR 2.5), and imaging-negative ischemia (HR 2.4) groups compared to the reference.
- Cardiovascular mortality risk was elevated in symptomatic cerebrovascular disease (HR 2.2) and covert vascular lesions (HR 2.3) groups, with a less pronounced increase in the imaging-negative ischemia group (HR 1.7).
Conclusions:
- All identified imaging phenotypes of cerebrovascular disease are associated with increased risks of recurrent ischemic stroke and mortality.
- Proactive and stringent preventive strategies are recommended for all patients with cerebrovascular disease, irrespective of the presence of overt symptoms or imaging evidence.
Background:
Diagnosis of cerebrovascular disease is based on both clinical and radiological findings, however, they do not always correlate.
Aims:
To investigate ischemic stroke recurrence and mortality in patients with different imaging phenotypes of ischemic cerebrovascular disease.
Methods:
Within the SMART-MR study, a prospective patient cohort with arterial disease, cerebrovascular diseases of participants at baseline were classified as no cerebrovascular disease (reference group, n = 828), symptomatic cerebrovascular disease (n = 204), covert vascular lesions (n = 156), or imaging negative ischemia (n = 90) based upon clinical and MRI findings. Ischemic strokes and deaths were collected at 6 month-intervals up to 17 years of follow-up. With Cox regression, relationships between phenotype and ischemic stroke recurrence, cardiovascular mortality, and non-vascular mortality were studied adjusted for age, sex, and cardiovascular risk factors.
Results:
Compared to reference group risk for recurrent ischemic stroke was increased not only in the symptomatic cerebrovascular disease (HR 3.9, 95% CI 2.3-6.6), but also in the covert vascular lesion (HR 2.5, 95% CI 1.3-4.8) and the imaging negative ischemia groups (HR 2.4, 95% CI 1.1-5.5). Risk for cardiovascular mortality was increased in the symptomatic cerebrovascular disease (HR 2.2, 95% CI 1.5-3.2) and covert vascular lesions groups (HR 2.3, 95% CI 1.5-3.4), while the risk was less strong but also increased in the imaging negative ischemia group (HR 1.7, 95% CI 0.9-3.0).
Conclusions:
People with all imaging phenotypes of cerebrovascular disease have increased risk of recurrent ischemic stroke and mortality compared to other arterial diseases. Strict preventive measures should be performed even when imaging findings or clinical symptoms are absent.
Data Access Statement:
For use of anonymized data, a reasonable request has to be made in writing to the UCC-SMART study group and the third party has to sign a confidentiality agreement.
