Ischemic stroke in eosinophilic granulomatosis with polyangiitis: a single-center retrospective cohort study

To examine the associations between clinical characteristics and the occurrence of ischemic stroke (IS), and to describe the clinical features and outcomes of IS in patients with eosinophilic granulomatosis with polyangiitis (EGPA).

In this single-center retrospective cohort study, 38 EGPA patients were stratified by ischemic stroke occurrence. Analyses included logistic regression and Kaplan-Meier survival analysis.

IS occurred in 8 patients (21.1%). The IS group had significantly higher rates of cardiac involvement (62.5% vs 20.0%, p = 0.031), active disease (BVAS ≥ 15: 87.5% vs 43.3%, p = 0.045), and Five-Factor Scores (p = 0.004). Strokes were predominantly bilateral (62.5%) and multifocal (75.0%). Cardiac involvement had a strong association with an increased risk (odds ratio = 15.0, 95% CI 2.3-97.0). Most patients (62.5%) achieved complete remission and functional independence after treatment.

Cardiac involvement is significantly associated with an increased risk of IS in EGPA, which presents with distinct bilateral/multifocal imaging patterns. Prompt immunosuppressive therapy is effective, but stroke recurrence remains a concern, underscoring the need for systematic cardiac screening and sustained long-term management.