title: Final 2 year results of the vascular imaging of acute stroke for identifying predictors of clinical outcome and recurrent ischemic eveNts (VISION) study.
abstract: Among patients with ischemic stroke, little attention has been paid to differentiation between stroke progression and recurrence. We assessed the role of MR imaging in predicting stroke progression, recurrent stroke, and death within 2 years of symptom onset.
  
  
  METHODS
  Ischemic stroke or TIA patients were prospectively enrolled. They were examined within 12 hours and had a stroke MR completed within 24 hours of symptom onset. Patients were closely followed neurologically and examined if there was any deterioration in neurological status. Relationships between baseline clinical and imaging factors and outcomes were assessed. We also examined whether baseline stroke/TIA severity (NIHSS 0-5 versus NIHSS > 5) modified these relationships.
  
  
  RESULTS
  A total of 334 patients were enrolled. The overall rates of progression, 2-year recurrence, and 2-year death were 8.7%, 8.0%, and 6.6%, respectively. Event rates were similar among patients with mild compared to more severe strokes: 8.3% versus 9.5% (p = 0.73) for progression, and 7.3% versus 9.9% (p = 0.59) for recurrence. The effect of baseline glucose > 8 mmol/l was consistent in predicting stroke progression, recurrent stroke and death, regardless of baseline stroke severity. In multivariable analyses, DWI lesion and intracranial occlusion predicted stroke progression only in the minor stroke/TIA group; symptomatic Internal Carotid Artery (ICA) stenosis predicted stroke recurrence only in the minor stroke/TIA group.
  
  
  CONCLUSIONS
  In a prospective study with early assessment and imaging we have found that stroke progression is different than stroke recurrence. Different imaging factors predict stroke progression versus stroke recurrence. Baseline hyperglycemia, a potentially modifiable factor, consistently predicted all three outcomes (stroke progression, recurrent stroke or death) regardless of baseline stroke severity.
authors.affiliation: Department of Clinical Neurosciences and Radiology, University of Calgary, Calgary, AB, T2N 2T9, Canada. scoutts@ucalgary.ca
authors.forename: Shelagh B
authors.initials: SB
authors.lastname: Coutts
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
authors.forename: Misha
authors.initials: M
authors.lastname: Eliasziw
authors.forename: Karyn
authors.initials: K
authors.lastname: Fischer
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D002545:Brain Ischemia / Q000175:diagnosis* / Q000401:mortality; D002533:Cerebral Angiography / Q000379:methods*; D038524:Diffusion Magnetic Resonance Imaging; D004185:Disability Evaluation; D018450:Disease Progression; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000401:mortality; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult