Stroke recurrence in the different subtypes of ischemic stroke. The importance of the intracranial disease

Abstract

The aim of the study was to analyze the long-term recurrence rate in patients with a first-ever ischemic stroke secondary to intracranial large artery atherosclerosis (LAA) in a Brazilian population. Methods: All stroke patients admitted to the hospital between October 2012 and September 2015 were evaluated. The stroke mechanism subtypes were classified as cardioembolism, LAA, small-vessel occlusion, other determined etiologies, and stroke of undetermined etiology. Results: The 359 first-ever ischemic stroke patients were followed up for a mean time of 21.6 ± 15.1 months. The LAA intracranial (38.9%) and extracranial (24.6%) stroke patients presented with a higher stroke recurrence. Intracranial LAA [HR, 10.2 (3.6–29.1); p < 0.001] and extracranial LAA [HR, 5.05 (1.79–14.2); p = 0.002] were the only conditions to show positive correlation with the recurrence rate, after adjusting for risk factors, thrombolysis, and National Institutes of Health Stroke Scale score at admission. Conclusion: Intracranial LAA presents a higher incidence of recurrence of ischemic stroke when compared with other etiologies in a Southern Brazilian population.

Inflammation‐regulatory microRNAs: Valuable targets for intracranial atherosclerosis

“…The prevalence of IS due to intracranial atherosclerosis (ICAS) among Asians is nearly 40%, which is larger than that among African‐Americans (29%) and Caucasians (15%) (Holmstedt, Turan, & Chimowitz, ; Suri & Johnston, ). ICAS remains the most common etiology of IS with the highest rate of recurrent stroke (Lange et al, ; Wang, Zhao, et al, ).…”

Incidence and Etiologies of Stroke Mimics After Incident Stroke or Transient Ischemic Attack

“…Some studies found an association between risk of recurrence and subtype, reporting the highest association for large-vessel disease and cardioembolic stroke. 185,[200][201][202] Other studies did not find any association between subtype and risk of recurrence. 34,68,160,203,204 Stroke due to large artery atherosclerosis has been consistently associated both with early recurrence and with recurrence in younger patients.…”

“…207 Hypertension, level of education, prior stroke, diabetes, coronary heart disease, silent brain infarction, alcohol abuse, persistent smoking, discontinuation of aspirin, atrial fibrillation and the total burden of risk factors have all been reported as significant risk factors for recurrent stroke in different studies. 160,166,173,186,194,202,203,[207][208][209][210][211][212][213][214][215][216][217]…”

Norberto Luiz Cabral, MD, PhD - (1963‒2019)

“…Always restless and inquisitor, Cabral, as he was called, published 52 articles and six book chapters on stroke and related problems. Fifteen articles were published by Archives of Neuro Neuropsychiatry 1,4,5,6,7,8,9,10,11,12 , including his publication debut, as many Brazilian researchers, in 1997 13 . In 2008 he received from the Brazilian Academy of Neurology the Award of Best Thesis of the Year, and in 2011 he received an International Scholarship by the British Association and the Brazilian Academy of Neurology.…”