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 - B M J Open
JF - B M J Open
IS - 10
M1 - e003724
ER -