Abstract Details

Title Predicting Stroke Risk in Symptomatic Intracranial Atherosclerotic Disease: Stroke Mechanisms as Another Dimension beyond Arterial Luminal Stenosis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 084

Objective To investigate the prognostic value of stroke mechanisms in symptomatic intracranial atherosclerotic disease (ICAD) for recurrent stroke.

Background Artery-to-artery embolism (AAE) and hypoperfusion are common stroke mechanisms in ICAD, which often coexist.

Design/Methods

Patients with acute ischemic stroke attributed to ICAD of 50-99% luminal stenosis were recruited in a cohort study. The severity of luminal stenosis was dichotomized as moderate (50-69%) and severe (70-99%). The probable stroke mechanisms were classified as coexisting AAE and hypoperfusion (A+H), or other single or mixed mechanisms, based on infarct topography in MRI and ICAD lesion features in MR/CT angiography. All patients received guideline-recommended medical treatment. The primary outcome was recurrent ischemic stroke in the same territory (SIT) within 1 year.

Results Among 122 symptomatic ICAD patients, 61 (50.0%) and 61 respectively had moderate and severe luminal stenosis. Forty-five (36.9%) patients had A+H, and other patients had parent artery atherosclerosis occluding penetrating artery (n=19, 15.6%), AAE alone (n=15, 12.3%), or hypoperfusion alone (n=43, 35.2%) as the probable stroke mechanisms. One-year risk of SIT was significantly higher in those with A+H as the stroke mechanism than otherwise (24.4% versus 7.8%; HR=3.40; 95% CI 1.25-9.20; P=0.010). When considering both the ICAD luminal stenosis and the stroke mechanisms, those with severe stenosis and A+H had the highest 1-year risk of SIT (33.3%), followed by moderate stenosis with A+H (14.3%), and severe or moderate stenosis without A+H (8.1 and 7.5%). Stroke mechanism of A+H was independently associated with the 1-year risk of SIT (HR=3.39; 95% CI 1.25-9.17; P=0.016), after adjusting for the severity of luminal stenosis in symptomatic ICAD.

Conclusions

Stroke mechanism is an important prognostic factor for stroke relapse in symptomatic ICAD. Coexisting AAE and hypoperfusion is associated with a high risk of recurrent relevant stroke despite optimal medical treatment, independent of the severity of luminal stenosis.

Authors/Disclosures
Xinyi Leng, PhD (The Chinese University of Hong Kong) PRESENTER	Dr. Leng has nothing to disclose.
	No disclosure on file
Lina Zheng	Miss Zheng has nothing to disclose.
Xuan Tian	Miss Tian has nothing to disclose.
Thomas W. Leung, MD (The Chinese University of Hong Kong)	Dr. Leung has nothing to disclose.

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