Association of covert brain infarct phenotype with stroke recurrence in first-ever manifest ischemic stroke according to etiology

Thomas Raphael Meinel; Stefan L Leber; Michael Janisch; Jan Vynckier; Adnan Mujanovic; Anna Boronylo; Johannes Kaesmacher; David Julian Seiffge; Laurent Roten; Marcel Arnold; Christian Enzinger; Thomas Gattringer; Urs Fischer; Markus Kneihsl

doi:10.1177/23969873241229612

Association of covert brain infarct phenotype with stroke recurrence in first-ever manifest ischemic stroke according to etiology

Eur Stroke J. 2024 Jan 30:23969873241229612. doi: 10.1177/23969873241229612. Online ahead of print.

Authors

Thomas Raphael Meinel¹, Stefan L Leber², Michael Janisch², Jan Vynckier¹, Adnan Mujanovic^{1

3}, Anna Boronylo¹, Johannes Kaesmacher³, David Julian Seiffge¹, Laurent Roten⁴, Marcel Arnold¹, Christian Enzinger⁵, Thomas Gattringer^{2

5}, Urs Fischer^{1

6}, Markus Kneihsl^{2

5

6}

Affiliations

¹ Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
² Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
³ Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁴ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁵ Department of Neurology, Medical University of Graz, Graz, Austria.
⁶ Department of Neurology University Hospital Basel, University of Basel, Basel, Switzerland.

PMID: 38288699
DOI: 10.1177/23969873241229612

Abstract

Introduction: Covert brain infarcts (CBI) are frequent incidental findings on MRI and associated with future stroke risk in patients without a history of clinically evident cerebrovascular events. However, the prognostic value of CBI in first-ever ischemic stroke patients is unclear and previous studies did not report on different etiological stroke subtypes. We aimed to test CBI phenotypes and their association with stroke recurrence in first-ever ischemic stroke patients according to stroke etiology.

Patients and methods: This study is a pooled data analysis of two prospectively collected cohorts of consecutive first-ever ischemic stroke patients admitted to the comprehensive stroke centers of Bern (Switzerland) and Graz (Austria). CBI phenotypes were identified on brain MRI within 72 h after admission. All patients underwent a routine follow-up (median: 12 months) to identify stroke recurrence.

Results: Of 1577 consecutive ischemic stroke patients (median age: 71 years), 691 patients showed CBI on brain MRI (44%) and 88 patients had a recurrent ischemic stroke (6%). Baseline CBI were associated with stroke recurrence in multivariable analysis (HR 1.9, 95% CI 1.1-3.3). CBI phenotypes with the highest risk for stroke recurrence were cavitatory CBI in small vessel disease (SVD)-related stroke (HR 7.1, 95% CI 1.6-12.6) and cortical CBI in patients with atrial fibrillation (HR 3.0, 95% CI 1.1-8.1).

Discussion and conclusion: This study reports a ≈ 2-fold increased risk for stroke recurrence in first-ever ischemic stroke patients with CBI. The risk of recurrent stroke was highest in patients with cavitatory CBI in SVD-related stroke and cortical CBI in patients with atrial fibrillation.Subject terms: Covert brain infarcts, stroke.

Keywords: Covert brain infarction; infarct phenotypes; stroke etiology; stroke recurrence.