title: Early recurrent ischemic lesions on diffusion-weighted imaging in symptomatic intracranial atherosclerosis.
abstract: 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.
authors.affiliation: Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. dwkang@amc.seoul.kr
authors.forename: Dong-Wha
authors.initials: DW
authors.lastname: Kang
authors.forename: Sun U
authors.initials: SU
authors.lastname: Kwon
authors.forename: Sung-Hee
authors.initials: SH
authors.lastname: Yoo
authors.forename: Kyum-Yil
authors.initials: KY
authors.lastname: Kwon
authors.forename: Choong Gon
authors.initials: CG
authors.lastname: Choi
authors.forename: Sang Joon
authors.initials: SJ
authors.lastname: Kim
authors.forename: Jae-Young
authors.initials: JY
authors.lastname: Koh
authors.forename: Jong S
authors.initials: JS
authors.lastname: Kim
mesh_terms: 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