Long-term recurrence of ischemic events in patients with intracranial atherosclerotic stenosis stratified by symptoms and pathogenesis

Yimeng Liu; Hongchen Zhao; Qiang Dong; Wenjie Cao

doi:10.1016/j.jns.2023.122838

Long-term recurrence of ischemic events in patients with intracranial atherosclerotic stenosis stratified by symptoms and pathogenesis

J Neurol Sci. 2024 Jan 15:456:122838. doi: 10.1016/j.jns.2023.122838. Epub 2023 Dec 13.

Authors

Yimeng Liu¹, Hongchen Zhao¹, Qiang Dong², Wenjie Cao³

Affiliations

¹ Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
² Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China; National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China. Electronic address: dongqiang2222@gmail.com.
³ Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China; National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China. Electronic address: wenjiecao@fudan.edu.cn.

PMID: 38171070
DOI: 10.1016/j.jns.2023.122838

Abstract

Background: Intracranial atherosclerotic stenosis (ICAS) can cause either transient ischemic attack (TIA) or acute ischemic stroke (AIS). Pathogenesis of ICAS-AIS can be divided into artery-to-artery embolism(A-A), hypoperfusion(HP), and parent-artery atherosclerosis occluding penetrating artery(POPA). However, the prognosis of each type remains uncertain. Our study aimed to investigate potential disparities in the recurrent risk among these four subtypes of symptomatic ICAS.

Methods: From a prospective, single-center cohort study of acute cerebrovascular diseases from January 2017 to November 2021, we recruited 120 ICAS patients and classified them into four groups based on diffusion weighted imaging. Patients were retrospectively followed up for recurrence in December 2022. The primary outcome was recurrent cerebral vascular events (RCVE) in the same territory.

Results: Among 120 recruited patients, POPA(33%) was the most common subtype, followed by A-A(32%), HP(29%), and TIA(6%). Cumulative recurrent rate was 31.2% with median months of follow-up as 27(20-45.5). There was no significant difference in the risk of RCVE in the same territory among four subgroups within three months. However, when considering the risk after three months, TIA(57%) had the highest risk of RCVE, followed by A-A(26%), while HP(4%) and POPA(8%) had lower risks (P = 0.001). Cox regression model indicated that symptom and pathogenesis was an independent risk factor for RCVE in long-term prognosis (P = 0.022), after adjusting for a history of hypertension and cerebral infarction.

Conclusions: Distinctive symptoms and pathogenesis of ICAS exhibit varying risks of RCVE in long-term prognosis. The differentiation in recurrent risk may provide valuable insights for guiding secondary prevention strategies.

Keywords: Imaging; Pathogenesis; Prognosis; Symptomatic intracranial atherosclerotic stenosis.

MeSH terms

Cohort Studies
Constriction, Pathologic / complications
Constriction, Pathologic / diagnostic imaging
Humans
Intracranial Arteriosclerosis* / complications
Intracranial Arteriosclerosis* / diagnostic imaging
Intracranial Arteriosclerosis* / epidemiology
Ischemic Attack, Transient* / complications
Ischemic Attack, Transient* / diagnostic imaging
Ischemic Attack, Transient* / epidemiology
Ischemic Stroke*
Prospective Studies
Recurrence
Retrospective Studies
Risk Factors
Stroke* / diagnostic imaging
Stroke* / epidemiology
Stroke* / etiology