Predictors of recurrent stroke in patients with symptomatic intracranial arterial stenosis.
OBJECTIVE
Our goal was to investigate whether initial ischemic lesion pattern can predict stroke recurrence in patients with symptomatic intracranial arterial stenosis.


METHODS
Of the Trial of Cilostazol in Symptomatic Intracranial Arterial Stenosis (TOSS)-2 trial participants, we included patients who underwent diffusion-weighted imaging and fluid attenuation inversion recovery imaging at baseline with a follow-up fluid attenuation inversion recovery imaging at 7 months. Based on the diffusion-weighted imaging findings, we classified the initial ischemic lesion patterns according to location (subcortical versus cortical versus subcorticocortical) and multiplicity (single versus multiple). We also evaluated the occurrence of new ischemic lesions on follow-up fluid attenuation inversion recovery as well as clinical stroke in the symptomatic intracranial arterial stenosis territory.


RESULTS
Of 353 patients included in this study, 44 (12.5%) and 13 (3.7%) patients had new ischemic lesions and clinical recurrent stroke in the initial symptomatic intracranial arterial stenosis territory, respectively. On multivariable analysis, the initial lesion patterns of subcorticocortical and multiple lesions were independent predictors of new ischemic lesions in the symptomatic intracranial arterial stenosis territory (OR, 3.01; 95% CI, 1.33-7.01; P=0.03; OR, 2.81; 95% CI, 1.34-5.9; P=0.006). These patterns also predicted clinical recurrent stroke.


CONCLUSIONS
Subcorticocortical lesions and multiple lesions are radiological predictors of recurrent ischemic stroke in symptomatic patients with intracranial arterial stenosis.  Clinical Trial Registration- URL: www.clinicaltrials.gov. Unique identifier: NCT00130039.
Department of Neurology, Korea University Ansan Hospital, Ansan, Korea.
Jin-Man
JM
Jung
Dong-Wha
DW
Kang
Kyung-Ho
KH
Yu
Ja-seong
JS
Koo
Ju-Hun
JH
Lee
Jong-Moo
JM
Park
Keun-Sik
KS
Hong
Yong-Jin
YJ
Cho
Jong S
JS
Kim
Sun U
SU
Kwon
D003251:Constriction, Pathologic / Q000145:classification* / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D020765:Intracranial Arterial Diseases / Q000145:classification* / Q000473:pathology*; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*