Intracranial arterial stenosis and recurrence in stroke patients with different risk stratifications by Essen stroke
Yue Suo1,2, Jing Jing1,2, Xia Meng1,2
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Insights
Intracranial arterial stenosis (ICAS) predicts stroke recurrence in low-risk patients but not high-risk patients, as determined by the Essen Stroke Risk score (ESRS). This finding highlights the importance of risk stratification in managing cerebrovascular events.
Area of Science:
- Neurology
- Vascular Neurology
- Stroke Medicine
Background:
- Intracranial arterial stenosis (ICAS) is a significant risk factor for stroke.
- The prognostic value of ICAS may vary based on patient risk stratification.
- The Essen Stroke Risk score (ESRS) is used to categorize stroke risk.
Purpose of the Study:
- To evaluate if the prognostic significance of ICAS differs across varying risk levels defined by the ESRS.
- To determine the association between ICAS and stroke recurrence at 3 and 12 months post-event.
Main Methods:
- Data from the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events trial were analyzed.
- Patients were stratified into low-risk (ESRS 0-2) and high-risk (ESRS ≥3) groups.
- Cox regression analysis was used to estimate hazard ratios for stroke recurrence associated with ICAS.
Main Results:
- In the low-risk group, ICAS was significantly associated with higher stroke recurrence at 3 months (HR=2.761) and 12 months (HR=2.540).
- In the high-risk group, ICAS was not significantly associated with stroke recurrence at 3 months (HR=1.501) or 12 months (HR=1.951).
- Stroke recurrence rates were 7.9% in the low-risk group and 9.6% in the high-risk group at 3 months.
Conclusions:
- ICAS is an independent predictor of stroke recurrence in low-risk patients.
- The prognostic value of ICAS for stroke recurrence is limited in high-risk patients stratified by ESRS.
- Risk stratification using ESRS is crucial for understanding the impact of ICAS on stroke recurrence.
Objectives:
We sought to investigate whether the prognostic value of intracranial arterial stenosis (ICAS) is consistent across different risk stratifications using the Essen Stroke Risk score (ESRS).
Methods:
We derived data from the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events trial. Patients without complete baseline brain imaging data were excluded. Participants were categorized into different risk groups based on ESRS (low risk, 0-2, and high risk ≥ 3). The main outcome was stroke recurrence within 3 and 12 months. Hazard ratios (HRs) and 95% confidence intervals (95%CIs) of ICAS, and other factors associated with stroke recurrence within 3 and 12 months were estimated using the Cox regression method.
Results:
During the 3-month follow-up, 54 patients (7.9%) had recurrent stroke in the low-risk group, and 39 patients (9.6%) had recurrent stroke in the high-risk group. ICAS was associated with a higher risk of stroke within 3 months (HR = 2.761; 95%CI = 1.538-4.957; P < 0.001) in the low-risk group, but not in the high-risk group (HR = 1.501; 95%CI = 0.701-3.213; P = 0.296). ICAS was independently associated with higher recurrent risk in the low-risk group (HR = 2.540; 95%CI = 1.472-4.381; P < 0.001), but not in the high-risk group (HR = 1.951; 95%CI = 0.977-3.893; P = 0.058) within 12 months.
Conclusion:
ICAS was an independent predictor of both 3- and 12-month stroke recurrence in low-risk but not high-risk patients with minor ischemic stroke or transient ischemic attack according to ESRS stratification.
