Concurrent intracranial and extracranial artery stenosis and the prognosis of transient ischaemic symptoms or imaging-negative ischaemic stroke

Abstract

Background and purposeTransient ischaemic attack (TIA), transient symptoms with infarction (TSI) and diffusion-weighted imaging (DWI)-negative acute ischaemic stroke (AIS) share similar aetiologies but are considered to have a rather benign prognosis. We intended to investigate the association between intracranial atherosclerotic stenosis (ICAS), extracranial atherosclerotic stenosis (ECAS) and the prognosis of patients with TIA, TSI and DWI-negative AIS.MethodsClinical and imaging data of eligible participants were derived from the Chinese Intracranial Atherosclerosis study, according to symptom duration, acute infarction on DWI and discharge diagnosis. Based on the severity and location of arterial atherosclerosis, we categorised the study population into four groups: no or <50% ICAS and no ECAS; ≥50% ICAS but no ECAS; no or <50% ICAS with ECAS; and concurrent ≥50% ICAS and ECAS. Using multivariable Cox regression models, we analysed the relationship between the severity and distribution of large artery atherosclerosis and the prognosis of TIA, TSI and DWI-negative AIS.ResultsA total of 806 patients were included, 67.3% of whom were male. The median age of the study participants was 63 years. Patients in the concurrent ≥50% ICAS and ECAS subgroup had both a significantly higher 1-year recurrence rate (adjusted HR 3.4 (95% CI 1.15 to 10.04), p=0.027) and a higher risk of composite vascular events (adjusted HR 3.82 (95% CI 1.50 to 9.72), p=0.005).ConclusionsConcurrent ICAS and ECAS is associated with a higher possibility of 1-year recurrent stroke or composite vascular events. Large artery evaluation is necessary to assess patients with transient ischaemic symptoms or DWI-negative AIS. Progress in shortening the time interval between symptom onset and large vessel evaluation is needed.

Demographic and risk factors profile of intracranial atherosclerotic stenosis in the Kingdom of Bahrain

“…We observed that patients with potentially symptomatic ICAS had a higher prevalence of ECAS. This coexistence can be explained by the fact that, as a systematic disease, atherosclerotic disease commonly affects multiple vascular beds [23,24].…”

Validation of the Canadian TIA Score to Predict Subsequent Stroke Risk in Chinese TIA Patients

“…In consideration of intracranial stenosis, prevalence is higher in Asians than Caucasians with TIA [20, 21], replacing “history of carotid stenosis” with “history of carotid or intracranial stenosis” which may make the Canadian TIA Score more suitable for Asians. Additional research studies with larger datasets of Asians can further refine the Canadian TIA Score to optimize stroke prevention.…”

Poststroke neutrophil count is predictive of the outcomes of large-artery atherosclerotic stroke and associated with craniocervical atherosclerosis

“…The evaluation of extracranial stenotic degree was consistent with the North American Symptomatic Carotid Endarterectomy Trial method 25 . The definition of AS was ≥ 50% stenosis or occlusion attributed to atherosclerosis on craniocervical large arteries 7 . The total number of craniocervical large arteries with an AS in each participant was counted as the craniocervical AS number.…”

“…Craniocervical atherosclerotic stenosis (AS), namely ≥ 50% stenosis or occlusion caused by atherosclerosis on craniocervical large arteries, is one of the major causes of acute ischemic stroke. A large body of evidence has demonstrated that the presence of and an increasing craniocervical AS number are detrimental to the functional outcomes and long-term prognoses of patients with stroke 1 – 7 . In a previous work, we used a semiquantitative method to quantify craniocervical atherosclerotic severity in patients with large-artery atherosclerotic (LAA) stroke, and found that the risk of poor 90-day functional outcome significantly increased along with the worsened craniocervical atherosclerotic severity in these patients 8 .…”