title: Prevalence and long-term clinical significance of intracranial atherosclerosis after ischaemic stroke or transient ischaemic attack: a cohort study.
abstract: OBJECTIVE
  We investigated the prevalence and long-term risk associated with intracranial atherosclerosis identified during routine evaluation.
  
  
  METHODS
  This study presents data from a prospective cohort of patients admitted to our stroke unit for thrombolysis evaluation.
  
  
  METHODS
  We included 652 with a final diagnosis of ischaemic stroke or transient ischaemic attack (TIA) from April 2009 to December 2011. All patients were acutely evaluated with cerebral CT and CT angiography (CTA). Acute radiological examinations were screened for intracranial arterial stenosis (IAS) or intracranial arterial calcifications (IAC). Intracranial stenosis was grouped into 30-50%, 50-70% and >70% lumen reduction. The extent of IAC was graded as number of vessels affected.
  
  
  METHODS
  Patients were followed until July 2013. Recurrence of an ischaemic event (stroke, ischaemic heart disease (IHD) and TIA) was documented through the national chart system. Poor outcome was defined as death or recurrence of ischaemic event.
  
  
  RESULTS
  101 (15.5%) patients showed IAS (70: 30-50%, 29: 50-70% and 16: >70%). Two-hundred and fifteen (33%) patients had no IAC, 339 (52%) in 1-2 vessels and 102 (16%) in >2 vessels. During follow-up, 53 strokes, 20 TIA and 14 IHD occurred, and 95 patients died. The risk of poor outcome was significantly different among different extents of IAS as well as IAC (log-rank test p<0.01 for both). In unadjusted analysis IAS and IAC predicted poor outcome and recurrent ischaemic event. When adjusted, IAS and IAC independently increased the risk of a recurrent ischaemic event (IAS: HR 1.67; CI 1.04 to 2.64 and IAC: HR 1.22; CI 1.02 to 1.47).
  
  
  CONCLUSIONS
  Intracranial atherosclerosis detected during acute evaluation predicts an increased risk of recurrent stroke.
authors.affiliation: Department of Neurology, Copenhagen University Hospital-Bispebjerg & Copenhagen Stroke Research Centre, Copenhagen, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Ovesen
authors.forename: Annemette
authors.initials: A
authors.lastname: Abild
authors.forename: Anders Fogh
authors.initials: AF
authors.lastname: Christensen
authors.forename: Sverre
authors.initials: S
authors.lastname: Rosenbaum
authors.forename: Christine Krarup
authors.initials: CK
authors.lastname: Hansen
authors.forename: Inger
authors.initials: I
authors.lastname: Havsteen
authors.forename: Jens Kellberg
authors.initials: JK
authors.lastname: Nielsen
authors.forename: Hanne
authors.initials: H
authors.lastname: Christensen
keywords: STROKE MEDICINE