title: Use of magnetic resonance angiography to predict long-term outcomes of ischemic stroke patients with concurrent stenoses in Hong Kong.
abstract: OBJECTIVE
  To determine the long-term outcome of ischemic stroke patients with concurrent intracranial and extracranial atherosclerosis using magnetic resonance angiography.
  
  
  METHODS
  A prospective cohort of patients in Hong Kong with acute ischemic stroke was studied with magnetic resonance angiography of the brain and carotid duplex. All patients were followed up regularly for the development of recurrent stroke, cardiac events, or death.
  
  
  RESULTS
  Totally 343 patients with acute ischemic stroke were included, of whom 104 (30%) had concurrent intracranial and extracranial lesions. The follow-up period was up to 76 months (mean 44.5 months). Overall, 55 patients (15.5%) died of any cause and 91 patients (26.5%) suffered a further nonfatal vascular event. The overall 5-year cumulative rates of mortality, restroke and poor outcomes (combined death and further vascular events) were 18, 27 and 37%, respectively. In patients with concurrent lesions, these rates were 31, 41 and 51%, respectively. The corresponding rates were 13, 22 and 31% in patients without concurrent lesions. The risks were highest in the first year after stroke. More deaths (log rank, 16.3; p = 0.0001), restrokes (log rank, 9.71; p = 0.002) and poor outcomes (log rank, 13.87; p = 0.0001) were found among patients with concurrent lesions. The presence of concurrent vascular lesions, advanced age, smoking, hyperlipidemia and previous history of stroke were independent predictors of poor outcomes.
  
  
  CONCLUSIONS
  The long-term prognosis of ischemic stroke patients with concurrent atherosclerosis of intracranial and extracranial vessels is poor. They are at high risk of further vascular events or death.
authors.affiliation: Division of Neurology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, SAR, China. manbikling@gmail.com
authors.forename: B L
authors.initials: BL
authors.lastname: Man
authors.forename: Y P
authors.initials: YP
authors.lastname: Fu
authors.forename: Y Y
authors.initials: YY
authors.lastname: Chan
authors.forename: W
authors.initials: W
authors.lastname: Lam
authors.forename: C F
authors.initials: CF
authors.lastname: Hui
authors.forename: W H
authors.initials: WH
authors.lastname: Leung
authors.forename: K S
authors.initials: KS
authors.lastname: Wong
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D002533:Cerebral Angiography / Q000379:methods*; D003251:Constriction, Pathologic; D005260:Female; D006723:Hong Kong; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D002537:Intracranial Arteriosclerosis / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D018616:Ultrasonography, Doppler, Duplex