Does cerebral infarction after a previous warning occur in the same vascular territory?

Area of Science:

• Neurology
• Vascular Neurology
• Stroke Medicine

Background:

• Transient ischemic attack (TIA) and nondisabling stroke are critical warning signs for future ischemic events.
• Understanding the territorial recurrence of ischemic strokes is vital for secondary prevention strategies.

Purpose of the Study:

• To compare the territory of cerebral infarcts on follow-up with the territory of the preceding transient ischemic attack (TIA) or nondisabling stroke.
• To investigate the likelihood and timing of recurrent ischemic strokes within the same vascular territory.

Main Methods:

• The study utilized data from the Dutch TIA Trial, a randomized, double-blind, controlled trial comparing aspirin dosages.
• Patients with TIA or nondisabling stroke were classified based on clinical symptoms and computed tomography into carotid or vertebrobasilar circulation territories.
• Follow-up data were analyzed to determine the occurrence and location of recurrent ischemic strokes.

Main Results:

• Of 2,371 patients with baseline events in the carotid circulation, 7.8% experienced a recurrent ischemic stroke within the same territory.
• In the vertebrobasilar group, 6.3% of patients had a recurrent stroke, with 55% occurring in the same territory as the initial event.
• Recurrent strokes in the same vascular territory were more common in the carotid groups and occurred significantly sooner after the initial event.

Conclusions:

• Single artery disease explains a significant portion, up to half, of follow-up strokes, with a higher prevalence in the carotid territory.
• Recurrent strokes originating from the same arterial lesion tend to manifest earlier than those from different lesions.