Risk factors, vascular lesion distribution, outcome and recurrence of strokes due to intracranial atherosclerosis: One year data from Hyderabad stroke registry

Abstract

Background:Intracranial atherosclerotic stenosis (ICAS) is a common cause of ischemic stroke in Asian countries and probably in India.Aim:The aim of this study was to describe the risk factors, distribution of vascular lesions, recurrence and outcome of stroke due to ICAS.Methodology:A total of 100 consecutive patients of ischemic stroke due to ICAS were enrolled prospectively from January 1, 2015, to December 31, 2015, and followed for 1 year for treatment compliance and recurrence. The details about demographics, risk factors, and vascular lesions were noted.Results:There were 68 males and 32 females. Hypertension (HTN), diabetes, alcohol, smoking, hyperlipidemia, and hyperhomocysteinemia was present in 82%, 52%, 34%, 33%, 28%, and 23%, respectively. The number of arteries involved were middle cerebral artery, 53 (37.3%); posterior cerebral artery, 24 (16.9%); internal cerebral artery, 21 (14.8%); vertebral artery, 18 (12.7%); basilar artery, 6 (4.2%); and anterior cerebral artery, 6 (4.2%). Seventeen (17%) patients had a recurrent stroke during 1 year follow-up. The presence of uncontrolled HTN and diabetes mellitus after discharge were significantly associated with stroke recurrence (P < 0.05). The use of dual antiplatelet agents and statins was found to have a significant effect in the prevention of recurrent stroke (P < 0.05). Severe stroke at presentation and presence of hemiparesis were the predictors for unfavorable outcome at 3 months (P < 0.05).Conclusion:Risk factors, distribution of vascular lesions and high recurrence of stroke due to ICAS in this study is similar to that reported from other Asian countries. Aggressive medical management and risk factor control remains the best strategy for preventing recurrence.

Experiences and needs of older adults at different stages of cerebral infarction based on trajectory theory—A qualitative study

“…Previous studies in China showed that a lack of understanding of the disease made patients fearful, uneasy and uncertain (Benoit et al, 2020). Disease management knowledge helped patients alleviate fear (Fukuoka et al, 2019), prevent disease recurrence and promote physical health (Ram et al, 2017). Therefore, clinicians should closely communicate with patients and their families and provide education about the disease, treatment, rehabilitation and recommended lifestyles.…”

Optimal Medical Management of Atherosclerotic Intracranial Stenosis

“…Patients with diabetes are known to be at higher risk of recurrent stroke due to sICAS, 17,[40][41][42][43][44][45] but there is a lack of compelling evidence to suggest that improved glycemic control results in better outcomes in patients with sICAS in large randomized controlled trials. A retrospective vessel wall magnetic resonance imaging study of 156 patients with 50% to 99% sICAS found diabetes (OR, 1.24 [95% CI, 1.04-3.79]; P=0.018) and enhancement ratios of culprit plaques (OR, 1.94 [95% CI, 1.27-3.09]; P<0.001) to be independently associated with risk of recurrent ischemic stroke.…”