title: Symptomatic steno-occlusion of cerebral arteries and subsequent ischemic events in patients with acute ischemic stroke.
abstract: BACKGROUND
  We aimed to assess the impact of symptomatic steno-occlusion (SYSO) of cerebral arteries and its characteristics on subsequent ischemic event (SIE) in patients with acute ischemic stroke.
  
  
  METHODS
  Using a prospective stroke registry database, we identified consecutive patients with ischemic stroke who were hospitalized within 48 hours of symptom onset. SYSO denoted significant stenosis or occlusion of major cerebral arteries with ischemic lesions at the corresponding arterial territories and was characterized by its location and severity. Primary outcome was SIE that was defined as ischemic progression or recurrence within 1 year.
  
  
  RESULTS
  In total, 1546 patients (age, 67.4 ± 13.0 years; median National Institutes of Health Stroke Scale score, 4) were enrolled in this study. The cumulative risk of SIE was 14.5% at 7 days, 14.9% at 14 days, 15.5% at 90 days, and 16.9% at 1 year. Patients with SYSO had significantly higher SIE rates compared with those without SYSO (23.0% versus 11.6%). Of the characteristics of SYSO, the location, not the severity, was significantly associated with SIE (P < .001 and P = .186, respectively). Multiple (adjusted hazard ratio, 5.85; 95% confidence interval, 1.81-18.85), intracranial internal carotid artery (ICA) (3.54; 1.21-8.21), and extracranial ICA SYSO (2.88; 1.01-8.21) raised the risk of SIE.
  
  
  CONCLUSIONS
  Subsequent cerebral ischemic events (progression or recurrence) after an acute ischemic stroke occur mostly within several days of stroke onset and is associated with the location, but not the severity, of symptomatic steno-occlusion of cerebral arteries.
authors.affiliation: Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea; Department of Neurology, Samsung Changwon Hospital, Sungkyunkwan University, Changwon, Korea; Department of Neurosurgery, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea.
authors.forename: Jihoon
authors.initials: J
authors.lastname: Kang
authors.affiliation: Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea.
authors.forename: Nayoung
authors.initials: N
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea.
authors.forename: Chang W
authors.initials: CW
authors.lastname: Oh
authors.affiliation: Department of Neurosurgery, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea.
authors.forename: O-Ki
authors.initials: OK
authors.lastname: Kwon
authors.affiliation: Department of Radiology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea.
authors.forename: Chol K
authors.initials: CK
authors.lastname: Jung
authors.affiliation: Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
authors.forename: Wook-Joo
authors.initials: WJ
authors.lastname: Kim
authors.affiliation: Department of Neurology, Dongguk University Gyeongju Hospital, Gyeongju, Korea.
authors.forename: Jung H
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea.
authors.forename: Youngchai
authors.initials: Y
authors.lastname: Ko
authors.affiliation: Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea.
authors.forename: Won-Young
authors.initials: WY
authors.lastname: Noh
authors.affiliation: Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea.
authors.forename: Min U
authors.initials: MU
authors.lastname: Jang
authors.affiliation: Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea.
authors.forename: Jeong-Ho
authors.initials: JH
authors.lastname: Hong
authors.affiliation: Department of Biostatistics, Soonchunhyang University Hospital, Seoul, Korea.
authors.forename: Ji S
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
authors.forename: Juneyoung
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea.
authors.forename: Myung S
authors.initials: MS
authors.lastname: Jang
authors.affiliation: Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea.
authors.forename: Mi H
authors.initials: MH
authors.lastname: Yang
authors.affiliation: Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea.
authors.forename: Moon-Ku
authors.initials: MK
authors.lastname: Han
authors.affiliation: Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea. Electronic address: braindoc@snu.ac.kr.
authors.forename: Hee-Joon
authors.initials: HJ
authors.lastname: Bae
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016893:Carotid Stenosis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D002533:Cerebral Angiography / Q000379:methods; D002539:Cerebral Arterial Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed
keywords: Ischemia; occlusion; prognosis; stenosis; stroke