Prevalence and long-term clinical significance of intracranial atherosclerosis after ischaemic stroke or transient ischaemic attack: a cohort study

Christian Ovesen; Annemette Abild; Anders Fogh Christensen; Sverre Rosenbaum; Inger Havsteen; Jens Kellberg Nielsen; Hanne Krarup Christensen

doi:10.1136/bmjopen-2013-003724

Prevalence and long-term clinical significance of intracranial atherosclerosis after ischaemic stroke or transient ischaemic attack: a cohort study

Christian Ovesen, Annemette Abild, Anders Fogh Christensen, Sverre Rosenbaum, Inger Havsteen, Jens Kellberg Nielsen, Hanne Krarup Christensen

Department of Clinical Medicine

23 Citations (Scopus)

Abstract

Objectives: We investigated the prevalence and longterm risk associated with intracranial atherosclerosis identified during routine evaluation. Design: This study presents data from a prospective cohort of patients admitted to our stroke unit for thrombolysis evaluation. Setting and participants: We included 652 with a final diagnosis of ischaemic stroke or transient ischaemic attack (TIA) from April 2009 to December 2011. All patients were acutely evaluated with cerebral CT and CT angiography (CTA). Acute radiological examinations were screened for intracranial arterial stenosis (IAS) or intracranial arterial calcifications (IAC). Intracranial stenosis was grouped into 30-50%, 50-70% and >70% lumen reduction. The extent of IAC was graded as number of vessels affected. Primary and secondary outcome measure: Patients were followed until July 2013. Recurrence of an ischaemic event (stroke, ischaemic heart disease (IHD) and TIA) was documented through the national chart system. Poor outcome was defined as death or recurrence of ischaemic event. Results: 101 (15.5%) patients showed IAS (70: 30-50%, 29: 50-70% and 16: >70%). Two-hundred and fifteen (33%) patients had no IAC, 339 (52%) in 1-2 vessels and 102 (16%) in >2 vessels. During follow-up, 53 strokes, 20 TIA and 14 IHD occurred, and 95 patients died. The risk of poor outcome was significantly different among different extents of IAS as well as IAC (log-rank test p<0.01 for both). In unadjusted analysis IAS and IAC predicted poor outcome and recurrent ischaemic event. When adjusted, IAS and IAC independently increased the risk of a recurrent ischaemic event (IAS: HR 1.67; CI 1.04 to 2.64 and IAC: HR 1.22; CI 1.02 to 1.47). Conclusions: Intracranial atherosclerosis detected during acute evaluation predicts an increased risk of recurrent stroke.

Original language	English
Article number	e003724
Journal	B M J Open
Volume	3
Issue number	10
Pages (from-to)	1-8
Number of pages	8
ISSN	2044-6055
DOIs	https://doi.org/10.1136/bmjopen-2013-003724
Publication status	Published - 2013

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title = "Prevalence and long-term clinical significance of intracranial atherosclerosis after ischaemic stroke or transient ischaemic attack: a cohort study",

abstract = "Objectives: We investigated the prevalence and longterm risk associated with intracranial atherosclerosis identified during routine evaluation. Design: This study presents data from a prospective cohort of patients admitted to our stroke unit for thrombolysis evaluation. Setting and participants: We included 652 with a final diagnosis of ischaemic stroke or transient ischaemic attack (TIA) from April 2009 to December 2011. All patients were acutely evaluated with cerebral CT and CT angiography (CTA). Acute radiological examinations were screened for intracranial arterial stenosis (IAS) or intracranial arterial calcifications (IAC). Intracranial stenosis was grouped into 30-50%, 50-70% and >70% lumen reduction. The extent of IAC was graded as number of vessels affected. Primary and secondary outcome measure: Patients were followed until July 2013. Recurrence of an ischaemic event (stroke, ischaemic heart disease (IHD) and TIA) was documented through the national chart system. Poor outcome was defined as death or recurrence of ischaemic event. Results: 101 (15.5%) patients showed IAS (70: 30-50%, 29: 50-70% and 16: >70%). Two-hundred and fifteen (33%) patients had no IAC, 339 (52%) in 1-2 vessels and 102 (16%) in >2 vessels. During follow-up, 53 strokes, 20 TIA and 14 IHD occurred, and 95 patients died. The risk of poor outcome was significantly different among different extents of IAS as well as IAC (log-rank test p<0.01 for both). In unadjusted analysis IAS and IAC predicted poor outcome and recurrent ischaemic event. When adjusted, IAS and IAC independently increased the risk of a recurrent ischaemic event (IAS: HR 1.67; CI 1.04 to 2.64 and IAC: HR 1.22; CI 1.02 to 1.47). Conclusions: Intracranial atherosclerosis detected during acute evaluation predicts an increased risk of recurrent stroke.",

author = "Christian Ovesen and Annemette Abild and Christensen, {Anders Fogh} and Sverre Rosenbaum and Inger Havsteen and Nielsen, {Jens Kellberg} and Christensen, {Hanne Krarup}",

year = "2013",

doi = "10.1136/bmjopen-2013-003724",

language = "English",

volume = "3",

pages = "1--8",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "10",

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TY - JOUR

T1 - Prevalence and long-term clinical significance of intracranial atherosclerosis after ischaemic stroke or transient ischaemic attack

T2 - a cohort study

AU - Ovesen, Christian

AU - Abild, Annemette

AU - Christensen, Anders Fogh

AU - Rosenbaum, Sverre

AU - Havsteen, Inger

AU - Nielsen, Jens Kellberg

AU - Christensen, Hanne Krarup

PY - 2013

Y1 - 2013

N2 - Objectives: We investigated the prevalence and longterm risk associated with intracranial atherosclerosis identified during routine evaluation. Design: This study presents data from a prospective cohort of patients admitted to our stroke unit for thrombolysis evaluation. Setting and participants: We included 652 with a final diagnosis of ischaemic stroke or transient ischaemic attack (TIA) from April 2009 to December 2011. All patients were acutely evaluated with cerebral CT and CT angiography (CTA). Acute radiological examinations were screened for intracranial arterial stenosis (IAS) or intracranial arterial calcifications (IAC). Intracranial stenosis was grouped into 30-50%, 50-70% and >70% lumen reduction. The extent of IAC was graded as number of vessels affected. Primary and secondary outcome measure: Patients were followed until July 2013. Recurrence of an ischaemic event (stroke, ischaemic heart disease (IHD) and TIA) was documented through the national chart system. Poor outcome was defined as death or recurrence of ischaemic event. Results: 101 (15.5%) patients showed IAS (70: 30-50%, 29: 50-70% and 16: >70%). Two-hundred and fifteen (33%) patients had no IAC, 339 (52%) in 1-2 vessels and 102 (16%) in >2 vessels. During follow-up, 53 strokes, 20 TIA and 14 IHD occurred, and 95 patients died. The risk of poor outcome was significantly different among different extents of IAS as well as IAC (log-rank test p<0.01 for both). In unadjusted analysis IAS and IAC predicted poor outcome and recurrent ischaemic event. When adjusted, IAS and IAC independently increased the risk of a recurrent ischaemic event (IAS: HR 1.67; CI 1.04 to 2.64 and IAC: HR 1.22; CI 1.02 to 1.47). Conclusions: Intracranial atherosclerosis detected during acute evaluation predicts an increased risk of recurrent stroke.

AB - Objectives: We investigated the prevalence and longterm risk associated with intracranial atherosclerosis identified during routine evaluation. Design: This study presents data from a prospective cohort of patients admitted to our stroke unit for thrombolysis evaluation. Setting and participants: We included 652 with a final diagnosis of ischaemic stroke or transient ischaemic attack (TIA) from April 2009 to December 2011. All patients were acutely evaluated with cerebral CT and CT angiography (CTA). Acute radiological examinations were screened for intracranial arterial stenosis (IAS) or intracranial arterial calcifications (IAC). Intracranial stenosis was grouped into 30-50%, 50-70% and >70% lumen reduction. The extent of IAC was graded as number of vessels affected. Primary and secondary outcome measure: Patients were followed until July 2013. Recurrence of an ischaemic event (stroke, ischaemic heart disease (IHD) and TIA) was documented through the national chart system. Poor outcome was defined as death or recurrence of ischaemic event. Results: 101 (15.5%) patients showed IAS (70: 30-50%, 29: 50-70% and 16: >70%). Two-hundred and fifteen (33%) patients had no IAC, 339 (52%) in 1-2 vessels and 102 (16%) in >2 vessels. During follow-up, 53 strokes, 20 TIA and 14 IHD occurred, and 95 patients died. The risk of poor outcome was significantly different among different extents of IAS as well as IAC (log-rank test p<0.01 for both). In unadjusted analysis IAS and IAC predicted poor outcome and recurrent ischaemic event. When adjusted, IAS and IAC independently increased the risk of a recurrent ischaemic event (IAS: HR 1.67; CI 1.04 to 2.64 and IAC: HR 1.22; CI 1.02 to 1.47). Conclusions: Intracranial atherosclerosis detected during acute evaluation predicts an increased risk of recurrent stroke.

U2 - 10.1136/bmjopen-2013-003724

DO - 10.1136/bmjopen-2013-003724

M3 - Journal article

C2 - 24148214

SN - 2044-6055

VL - 3

SP - 1

EP - 8

JO - BMJ Open

JF - BMJ Open

IS - 10

M1 - e003724

ER -

Prevalence and long-term clinical significance of intracranial atherosclerosis after ischaemic stroke or transient ischaemic attack: a cohort study

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