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


摘要Background 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.
著者Xueyan Feng, Ka Lung Chan, Linfang Lan, Jill Abrigo, Hui Fang, Yuming Xu, Yannie Soo, Xinyi Leng, Thomas W. Leung
會議名稱5th European Stroke Organisation Conference
會議論文集題名European Stroke Journal
系列標題E-poster Viewing
期次Suppl 1
出版地Sage Publications
頁次543 - 543
關鍵詞intracranial atherosclerosis, stroke mechanism, stroke recurrence, artery-to-artery embolism, hypoperfusion

上次更新時間 2020-10-07 於 03:35