Abstract Details

Title Prevalence, Predictors, and Prognosis of Intracranial Stenosis in Patients with TIA and Minor Stroke: Population-based Study Versus Randomized Trials

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S60 - Cerebrovascular Imaging and Biomarkers (1:24 PM-1:36 PM)

Poster/Presentation
Number 003

Objective To study the age-specific prevalence, predictors and prognosis of symptomatic intracranial stenosis (ICS) in a population-based cohort of Caucasian patients with TIA/minor stroke on intensive medical management.

Background Symptomatic ICS was perceived to convey a high risk of recurrent stroke but trials (SAMMPRIS and VISSIT) failed to show superiority of stenting over intensive medical management alone, due partly to a lower than expected risk of recurrent stroke possibly reflecting the young age of participants (mean age<60) and raising questions about generalizability to routine practice.

Design/Methods All patients recruited to the population-based Oxford Vascular Study between 2011-2018 with TIA/minor ischemic stroke (NIHSS≤3), irrespective of age, were included. Imaging was preferentially by MR angiography (MRA), with CT angiography (CTA) or transcranial Doppler ultrasound in the case of contraindications. We determined the age-specific prevalence of ≥50% ICS and the associated stroke risk (adjusted for age and vascular risk factors) by follow-up to 2019 on intensive medical treatment without stenting.

Results Of 1368 eligible imaged patients (mean/SD age= 69.2/13.9 years), 261 (19.1%; 17.7% TIA, 21.6% stroke) had a total of 424 symptomatic or asymptomatic ICS. The prevalence of any ICS increased with age (p_trend<0.0001). Of 106 patients with symptomatic ICS, 14 had recurrent ischemic strokes during mean follow-up of 3.2 years. The 2-year risks of ischemic stroke (9.3%, 95% CI 3.4-15.2) and of any stroke or death (21.8%, 12.6-31.0) were comparable to the medical treatment arms of the trials. Symptomatic ICS increased risk of ischemic stroke (adjusted HR= 1.47, 1.09-1.98) compared to no ICS, but asymptomatic ICS did not.

Conclusions The prevalence of ICS increases steeply with age in predominantly Caucasian patients with TIA/minor stroke, but the risk of recurrent stroke on intensive medical treatment is consistent with randomized trials in younger cohorts, supporting their generalizability to routine practice.

Authors/Disclosures
Robert Hurford, MBBS, PhD PRESENTER	Dr. Hurford has nothing to disclose.
Frank Wolters (Erasmus Medical Center)	No disclosure on file
Linxin Li, MD	The institution of Dr. Li has received research support from Medical Research Foundation.
Gary K. Lau, MBBS (University of Hong Kong)	Dr. Lau has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Lau has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Lau has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Daiichi Sankyo. Dr. Lau has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Amgen. Dr. Lau has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Boehringer Ingelheim. Dr. Lau has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Daiichi Sankyo. Dr. Lau has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Pfizer. Dr. Lau has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Eisai. Dr. Lau has stock in ReMobility. The institution of Dr. Lau has received research support from Croucher Foundation. The institution of Dr. Lau has received research support from Research Fund Secretariat of the Food and Health Bureau, Hong Kong. The institution of Dr. Lau has received research support from Innovation and Technology Bureau, Hong Kong. The institution of Dr. Lau has received research support from Research Grants Council, Hong Kong. Dr. Lau has received publishing royalties from a publication relating to health care.
	No disclosure on file
	No disclosure on file

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