Mechanisms of recurrence in subtypes of ischemic stroke: a hospital-based follow-up study.
BACKGROUND
Information on the mechanism of recurrent stroke may help physicians treating patients with ischemic stroke. However, the mechanisms of recurrence in each stroke subtype are not well known, especially in Asians.


OBJECTIVE
To compare the mechanisms of the index and recurrent stroke.


METHODS
Analysis of data from a prospective acute stroke registry.


METHODS
University hospital.


METHODS
Using the clinical syndrome, diffusion-weighted imaging, and vascular studies, we divided 901 patients into 5 groups: large-artery atherosclerosis, cardioembolism, small-artery disease, parent-artery disease occluding the deep perforators, and no determined cause. The patients with large-artery atherosclerosis were subdivided into 2 groups: intracranial and extracranial.


METHODS
The mechanisms of recurrent vascular events (strokes or coronary heart disease) in subtypes of ischemic stroke were compared.


RESULTS
Ninety-three recurrent vascular events (86 strokes and 7 instances of coronary heart disease) were evaluated. The pattern of recurrent stroke differed for the intracranial and extracranial groups; unlike the patients with intracranial large-artery atherosclerosis, recurrent strokes in the extracranial group were often unpredictable with respect to the site of recurrence and degree of preexisting stenosis. None of the patients in the extracranial group had recurrences that were caused by intracranial large-artery atherosclerosis or vice versa. In patients with small-artery disease and stroke with no determined cause, intracranial stenosis was often found at the time of recurrence.


CONCLUSIONS
From prognostic and therapeutic perspectives, patients with atherosclerosis should be divided into those with intracranial large-artery atherosclerosis and extracranial large-artery atherosclerosis. In addition, intracranial large-artery atherosclerosis may be important in the development of small-artery disease and stroke with no determined cause, especially in the population with a higher frequency of intracranial large-artery atherosclerosis.
Shin
Dong Hoon
DH
Department of Neurology, School of Medicine, Ajou University, Suwon, South Korea.
Lee
Phil Hyu
PH
Bang
Oh Young
OY
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D002545:Brain Ischemia / Q000145:classification / Q000175:diagnosis / Q000209:etiology*; D002340:Carotid Artery Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020243:Infarction, Anterior Cerebral Artery / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D002537:Intracranial Arteriosclerosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D020766:Intracranial Embolism / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D020521:Stroke / Q000145:classification / Q000175:diagnosis / Q000209:etiology*