title: Imaging and clinical predictors of unfavorable outcome in medically treated symptomatic intracranial atherosclerotic disease.
abstract: BACKGROUND
  Patients with symptomatic intracranial atherosclerotic disease (sICAD) have an increased risk of stroke and vascular death. The aim of the study was to evaluate the natural history and outcome of patients with sICAD treated medically.
  
  
  METHODS
  The study population was first-ever transient ischemic attack (TIA) or stroke patients presenting to our institute who on vascular imaging had isolated intracranial atherosclerosis as cause of their symptoms and have a follow-up of 90 days. Unfavorable outcome was defined as occurrence of TIA, stroke, acute coronary event, and/or vascular death.
  
  
  RESULTS
  Fifty-three (11.8%) of the 449 ischemic stroke patients had sICAD. The risk of stroke in sICAD was 8.9%, 11.1%, 13.3%, and 15.6% in first 7 days, 30 days, 90 days, and 1 year, respectively. Five (11.1%) had cardiovascular events and accounted for 50% of mortality. The predictors of unfavorable outcome were presented as limb weakness (85.7% versus 58.8%, hazard ratio 1.5; 95% confidence interval [CI], .05-.9; P = .04), National Institutes of Health Stroke Scale (NIHSS) score 8 at admission (50% versus 5.9%, hazard ratio 8.5; 95% CI, .007-.5; P = .02), magnetic resonance imaging (MRI) with multiple diffusion-weighted imaging (DWI) lesions (65.4% versus 26.7%; 95% CI, .04-.7; P = .01), and angiography suggestive of diffuse atherosclerosis (50% versus 11.8%; 95% CI, odds ratio .02-.7; P = .009). On stepwise multiple regression, variables for unfavorable outcome were NIHSS score of 8 or more at admission (P = .001), multiple DWI lesion on MRI (P = .04), and diffuse atherosclerosis on angiography (P = .006).
  
  
  CONCLUSIONS
  The patients with sICAD have a high risk of stroke and cardiac events even on aggressive medical treatment. Clinical and imaging features can identify this high-risk group.
authors.affiliation: Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Kate
authors.affiliation: Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India. Electronic address: sylajapn@hotmail.com.
authors.forename: Padmavathy N
authors.initials: PN
authors.lastname: Sylaja
authors.affiliation: Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
authors.forename: Chandrasekharan
authors.initials: C
authors.lastname: Kesavadas
authors.affiliation: Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
authors.forename: Bejoy
authors.initials: B
authors.lastname: Thomas
mesh_terms: D000368:Aged; D002533:Cerebral Angiography / Q000379:methods; D038524:Diffusion Magnetic Resonance Imaging; D004185:Disability Evaluation; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007194:India; D002537:Intracranial Arteriosclerosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016015:Logistic Models; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Intracranial atherosclerotic disease; TIA; intracranial stenosis; predictors; stroke; treatment