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Imaging Markers Predict the Short-Term and Long-Term Stroke Recurrence in Symptomatic Intracranial Atherosclerotic
Rinta Paul1, Anagha Rajiv1, Adarsh Anil Kumar2
1Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.
Insights
A territorial and cortical infarct pattern independently predicts early stroke recurrence in patients with symptomatic intracranial atherosclerotic disease (ICAD). This finding highlights potential mechanisms like artery-to-artery embolism and plaque instability.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Stroke Research
Background:
- Symptomatic intracranial atherosclerotic disease (ICAD) carries a high risk of stroke recurrence, even with aggressive medical treatment.
- Recurrence rates and risk factors in non-Western populations, such as India, are less understood.
- This study investigates predictors of early and late stroke recurrence in Indian patients with symptomatic ICAD.
Purpose of the Study:
- To identify clinical and imaging predictors of early (within 3 months) and late (3 months to 1 year) stroke recurrence in patients with symptomatic ICAD.
- To evaluate the independent predictive value of a territorial and cortical infarct pattern on stroke recurrence.
Main Methods:
- An ambispective cohort study included 229 patients with symptomatic ICAD from a tertiary stroke care hospital in India.
- Data collected included intracranial arterial stenosis, infarct patterns, white matter hyperintensity (WMH), and collateral flow.
- Recurrent stroke or transient ischemic attack (TIA) within 3 months and 1 year were the primary outcomes.
Main Results:
- Recurrent ischemic stroke or TIA occurred in 24% of patients within one year.
- Early recurrence (within 3 months) affected 20.5% of patients, while late recurrence (after 3 months) affected 6.1%.
- A territorial and cortical infarct pattern was an independent predictor of early stroke recurrence (adj. OR, 2.15; p=0.028).
Conclusions:
- A territorial and cortical infarct pattern is a significant independent predictor of early stroke recurrence in symptomatic ICAD.
- Artery-to-artery embolism and plaque instability are suggested as potential mechanisms driving early stroke recurrence.
- Findings emphasize the importance of infarct patterns in risk stratification for ICAD patients.
Introduction:
Symptomatic intracranial atherosclerotic disease (ICAD) is associated with a high risk of stroke recurrence despite aggressive medical management. However, recurrence rates and risk factors are less studied in non-Western settings. The study evaluated the clinical and imaging predictors of early and late stroke recurrence in patients with symptomatic ICAD in India.
Methods:
This ambispective cohort study enrolled patients with symptomatic ICAD within 1 month of symptom onset from a tertiary stroke care hospital. The intracranial arterial stenosis grade and length, infarct patterns, white matter hyperintensity (WMH), and collateral flow were documented. The primary outcome was recurrent stroke or transient ischemic attack (TIA) within 3 months and 1 year.
Results:
Of 876 patients with large artery atherosclerosis, 229 patients were included (mean age 59.7 ± 10.2 years; men, 72.9%). At the end of 1-year follow-up, recurrent ischemic stroke or TIA occurred in 55 (24%) patients. Of these, 47 (20.5%) patients had stroke recurrence within 3 months (early), and 14 (6.1%) patients had stroke recurrence after 3 months to 1 year (late). Six patients had both early and late stroke recurrence. A territorial and cortical infarct pattern (p = 0.038), moderate to severe WMH (p = 0.050), hypertension (p = 0.040), diabetes (p = 0.043), and coronary artery disease (p = 0.034) predicted early stroke recurrence. A territorial and cortical infarct pattern (p = 0.026), greater length of stenosis (p = 0.045), diabetes (p = 0.026), and coronary artery disease (p = 0.044) predicted late recurrence. On multivariate analysis, a territorial and cortical infarct pattern (adj. OR: 2.15; 95% CI: 1.09-4.26; p = 0.028) independently predicted early stroke recurrence.
Conclusion:
A territorial and cortical infarct pattern is an independent predictor of early stroke recurrence, suggesting the role of artery-to-artery embolism and plaque instability as a potential mechanism of early stroke recurrence in patients with symptomatic ICAD.
