Association of intracranial large artery disease with long-term prognosis after ischaemic stroke
Wan-Yun Sabrina Liu1, Kaavya Narasimhalu2, Fung Peng Woon3
1Duke-NUS Medical School, Singapore.
Insights
Intracranial large artery disease (ICLAD) increases stroke patients' risk of long-term vascular events, including heart attack and vascular death. Early screening and prevention are crucial for this high-risk group.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Background:
- Intracranial large artery disease (ICLAD) is a significant cause of ischemic stroke.
- ICLAD is linked to an increased risk of short-term recurrent vascular events.
Purpose of the Study:
- To compare long-term vascular outcomes in ischemic stroke patients with and without ICLAD.
- To assess the prognostic impact of ICLAD on recurrent stroke, myocardial infarction, and vascular death.
Main Methods:
- A longitudinal observational study of 581 acute ischemic stroke patients.
- Serial follow-up for up to 86 months to record vascular events.
- Diagnosis of ICLAD using transcranial color-coded Doppler ultrasound.
Main Results:
- 60.9% of patients had ICLAD.
- ICLAD patients showed higher risks of composite long-term vascular outcomes (HR 1.44), myocardial infarction (HR 2.89), and vascular death (HR 3.52).
- No significant difference in recurrent stroke rates was observed between groups (HR 1.10).
Conclusions:
- ICLAD has a poor prognostic impact on long-term vascular events following ischemic stroke.
- Specific screening and secondary prevention strategies are needed for ICLAD patients.
- Emphasis on coronary artery disease prevention is recommended for this high-risk population.
Introduction:
Intracranial large artery disease (ICLAD) is a common cause of ischaemic stroke and is associated with the risk of recurrent vascular events in the short term. We compared the incidence of various long-term vascular outcomes between ischaemic stroke patients with and without ICLAD.
Methods:
This was a longitudinal observational study of acute ischaemic stroke patients who were followed up serially for recurrent stroke, myocardial infarction or vascular death up to a median of 86 months. Transcranial colour-coded Doppler was used in the diagnosis of ICLAD.
Results:
Among the 581 ischaemic stroke patients studied (median age 63 ± 11 years, male 71%), 354 (60.9%) had ICLAD. In regression analyses adjusting for covariates, patients with ICLAD were more likely to have long-term composite vascular outcomes (hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.02-2.03, P = 0.041), myocardial infarction (HR 2.89, 95% CI 1.71-4.91, P < 0.001) and vascular death (HR 3.52, 95% CI 1.67-7.52, P = 0.001) but not recurrent stroke (HR 1.10, 95% CI 0.72-1.70, P = 0.652), at a median of 86 months as compared to patients without ICLAD.
Conclusion:
Our findings of poor prognostic impact of ICLAD on long-term recurrent vascular events after ischaemic stroke provide evidence for the need of specific, emphasised screening and secondary prevention, especially for coronary artery disease in this high-risk group.
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