Early recurrent ischemic lesions on diffusion-weighted imaging in symptomatic intracranial atherosclerosis.
BACKGROUND
Prior observations have shown that early recurrent ischemic lesions (ERILs) on diffusion-weighted imaging occur frequently within the first week after an index stroke.


OBJECTIVE
To investigate differential patterns of ERILs among stroke subtypes, particularly intracranial large-artery atherosclerosis (IC-LAA).


METHODS
Retrospective study.


METHODS
Tertiary university hospital.


METHODS
We included 133 patients who experienced an acute ischemic stroke and who underwent initial diffusion-weighted imaging within 24 hours and subsequent diffusion-weighted imaging within 7 days after onset, and whose stroke subtype was IC-LAA, extracranial LAA (EC-LAA), or cardioembolism (CE).


METHODS
Early recurrent ischemic lesions were defined as new ischemic lesions on follow-up diffusion-weighted imaging, separate from the index stroke lesion.


RESULTS
Early recurrent ischemic lesions were observed in the following proportions: 50.9% (28/55) in the IC-LAA group, 47.4% (9/19) in the EC-LAA group, and 44.1% (26/59) in the CE group. Early recurrent ischemic lesions in the IC-LAA group had the following characteristics: (1) they occurred mostly (27 [96.4%] of 28) in the pial area of the same vascular territory as the index stroke; (2) they were more frequently observed in a higher grade of stenosis than in milder stenosis (P<.001), whereas ERILs in the EC-LAA group were not related to the degree of stenosis; (3) they were not associated with subsequent recanalization, whereas ERILs in the CE group were mostly associated with subsequent recanalization (P<.001); and (4) they were more closely associated with clinical recurrence than in the EC-LAA or CE group (P=.02).


CONCLUSIONS
Early recurrent ischemic lesions in the IC-LAA group are relatively frequent and have different patterns than in the EC-LAA or CE group.
Kang
Dong-Wha
DW
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. dwkang@amc.seoul.kr
Kwon
Sun U
SU
Yoo
Sung-Hee
SH
Kwon
Kyum-Yil
KY
Choi
Choong Gon
CG
Kim
Sang Joon
SJ
Koh
Jae-Young
JY
Kim
Jong S
JS
D000368:Aged; D001931:Brain Mapping; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications* / Q000175:diagnosis*; D002546:Ischemic Attack, Transient / Q000145:classification / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors