Classifying stroke mechanisms in symptomatic intracranial atherosclerotic disease: the reproducibility and clinical correlates
Refereed conference paper presented and published in conference proceedings

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AbstractBackground and Aims: In patients with symptomatic intracranial atherosclerotic stenosis (ICAS), identifying the underlying stroke mechanisms may inform secondary prevention. We aimed to propose reproducible classification criteria for stroke mechanisms based on routine neuroimaging in symptomatic ICAS and explore their associations with stroke recurrence.
Methods: We recruited patients with acute ischemic stroke attributed to 50–99% ICAS in anterior circulation from two centers. Two investigators independently classified probable stroke mechanisms as parent artery atherosclerosis occluding penetrating artery, artery-to-artery embolism, hypoperfusion, and mixed mechanisms, with prespecified criteria based on infarct topography and MR/CT angiography. These stroke mechanisms were correlated with recurrent relevant ischemic stroke or transient ischemic attack (TIA) within 1 year.
Results: Among 153 patients recruited, the most common stroke mechanisms were hypoperfusion (35.9%), and mixed mechanism of artery-toartery embolism and hypoperfusion (35.9%) that was associated with higher incidence of dyslipidemia (p¼ 0.045) and hypertension (p¼ 0.030) than patients with other stroke mechanisms. The proposed criteria showed substantial to excellent intra-rater and inter-rater reproducibilities (kappa 0.715-0.871) in 122 cases. Overall, 31 patients received interventional treatment of the diseased intracranial artery; 122 received medical treatment, among whom a mixed mechanism of artery-to-artery embolism and hypoperfusion at baseline was associated with higher risk of recurrent relevant ischemic stroke or TIA within 1 year (HR 3.09; 95% CI 1.26-7.60; logrank p = 0.007; Figure), than other mechanisms combined.
Conclusions: Artery-to-artery embolism and hypoperfusion commonly coexist in ischemic stroke attributed to ICAS, which may be associated with a higher risk of stroke relapse.
Acceptance Date16/03/2019
All Author(s) ListXueyan Feng, Ka Lung Chan, Linfang Lan, Jill Abrigo, Hui Fang, Yuming Xu, Yannie Soo, Xinyi Leng, Thomas W. Leung
Name of Conference5th European Stroke Organisation Conference
Start Date of Conference22/05/2019
End Date of Conference24/05/2019
Place of ConferenceMilan
Country/Region of ConferenceItaly
Proceedings TitleEuropean Stroke Journal
Series TitleE-poster Viewing
Number in SeriesAS17-057
Year2019
Month5
Volume Number4
Issue NumberSuppl 1
Place of PublicationSage Publications
Pages543 - 543
ISSN23969873
eISSN23969881
LanguagesEnglish-United States
Keywordsintracranial atherosclerosis, stroke mechanism, stroke recurrence, artery-to-artery embolism, hypoperfusion

Last updated on 2020-29-05 at 02:06