title: Association of multiple infarctions and ICAS with outcomes of minor stroke and TIA.
abstract: OBJECTIVE
  To estimate the association of different patterns of infarction and intracranial arterial stenosis (ICAS) with the prognosis of acute minor ischemic stroke and TIA.
  
  
  METHODS
  We derived data from the Clopidogrel in High-risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial. A total of 1,089 patients from 45 of 114 participating sites of the trial undergoing baseline MRI/angiography were included in this subgroup analysis. Patterns of infarction and ICAS were recorded for each individual. The primary efficacy outcome was an ischemic stroke at the 90-day follow-up. We assessed the associations between imaging patterns and prognosis of patients using multivariable Cox regression models.
  
  
  RESULTS
  Among the 1,089 patients included in this subgroup analysis, 93 (8.5%) patients had a recurrent ischemic stroke at 90 days. Compared with those without infarction or ICAS, patients with single infarction with ICAS (11.9% vs 1.3%, hazard ratio [HR] 6.25, 95% confidence intervals [CIs] 1.40-27.86,p= 0.02) and single infarction without ICAS (6.8% vs 1.3%, HR 4.65, 95% CI 1.05-20.64,p= 0.04) were all associated with an increased risk of ischemic stroke at 90 days. Patients with both multiple infarctions and ICAS were associated with approximately 13-fold risk of ischemic stroke at 90 days (18.0% vs 1.3%, HR 13.14, 95% CI 2.96-58.36,p< 0.001).
  
  
  CONCLUSIONS
  The presence of multiple infarctions and ICAS were both associated with an increased risk of 90-day ischemic stroke in patients with minor stroke or TIA, while the presence of both imaging features had a combined effect.
  
  
  BACKGROUND
  NCT00979589.
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang), and Department of Epidemiology and Health Statistics, School of Public Health (Y.P.), Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Municipal Key Laboratory of Clinical Epidemiology (Y.P.), China; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Dell Medical School (S.C.J.), University of Texas at Austin.
authors.forename: Yuesong
authors.initials: Y
authors.lastname: Pan
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang), and Department of Epidemiology and Health Statistics, School of Public Health (Y.P.), Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Municipal Key Laboratory of Clinical Epidemiology (Y.P.), China; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Dell Medical School (S.C.J.), University of Texas at Austin.
authors.forename: Xia
authors.initials: X
authors.lastname: Meng
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang), and Department of Epidemiology and Health Statistics, School of Public Health (Y.P.), Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Municipal Key Laboratory of Clinical Epidemiology (Y.P.), China; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Dell Medical School (S.C.J.), University of Texas at Austin.
authors.forename: Jing
authors.initials: J
authors.lastname: Jing
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang), and Department of Epidemiology and Health Statistics, School of Public Health (Y.P.), Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Municipal Key Laboratory of Clinical Epidemiology (Y.P.), China; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Dell Medical School (S.C.J.), University of Texas at Austin.
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang), and Department of Epidemiology and Health Statistics, School of Public Health (Y.P.), Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Municipal Key Laboratory of Clinical Epidemiology (Y.P.), China; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Dell Medical School (S.C.J.), University of Texas at Austin.
authors.forename: Xingquan
authors.initials: X
authors.lastname: Zhao
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang), and Department of Epidemiology and Health Statistics, School of Public Health (Y.P.), Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Municipal Key Laboratory of Clinical Epidemiology (Y.P.), China; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Dell Medical School (S.C.J.), University of Texas at Austin.
authors.forename: Liping
authors.initials: L
authors.lastname: Liu
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang), and Department of Epidemiology and Health Statistics, School of Public Health (Y.P.), Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Municipal Key Laboratory of Clinical Epidemiology (Y.P.), China; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Dell Medical School (S.C.J.), University of Texas at Austin.
authors.forename: David
authors.initials: D
authors.lastname: Wang
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang), and Department of Epidemiology and Health Statistics, School of Public Health (Y.P.), Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Municipal Key Laboratory of Clinical Epidemiology (Y.P.), China; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Dell Medical School (S.C.J.), University of Texas at Austin.
authors.forename: S Claiborne
authors.initials: SC
authors.lastname: Johnston
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang), and Department of Epidemiology and Health Statistics, School of Public Health (Y.P.), Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Center of Stroke (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (Y.P., X.M., J.J., H.L., X.Z., L.L., Yilong Wang, Yongjun Wang); Beijing Municipal Key Laboratory of Clinical Epidemiology (Y.P.), China; INI Stroke Network (D.W.), OSF Healthcare System, University of Illinois College of Medicine, Peoria; and Dell Medical School (S.C.J.), University of Texas at Austin. yongjunwang1962@gmail.com yilong528@gmail.com.
authors.forename: Yilong
authors.initials: Y
authors.lastname: Wang
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging; D020520:Brain Infarction / Q000000981:diagnostic imaging / Q000209:etiology*; D002545:Brain Ischemia / Q000150:complications; D000077144:Clopidogrel; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D002537:Intracranial Arteriosclerosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D002546:Ischemic Attack, Transient / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D020521:Stroke / Q000150:complications* / Q000209:etiology; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin