Rajbeer S Sangha1, Shyam Prabhakaran2, Edward Feldmann3, Tristan Honda4, Azhar Nizam5, George A Cotsonis5, Iszet Campo-Bustillo6, Jose G Romano6, David S Liebeskind4. 1. Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States. 2. Department of Neurology, The University of Chicago, Chicago, IL, United States. 3. Department of Neurology, The University of Massachusetts Medical School-Baystate, Springfield, MA, United States. 4. Department of Neurology, University of California at Los Angeles, Los Angeles, CA, United States. 5. Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States. 6. Department of Neurology, University of Miami, Miami, FL, United States.
Abstract
Introduction: While much is known about recurrent clinical events in patients with intracranial atherosclerotic disease (ICAD), there is limited data on characteristics of recurrent infarcts. Methods: The NIH-funded MyRIAD prospective, observational study was designed to identify mechanisms of ischemia and predictors of recurrence in ICAD. Recurrent infarction was assessed on MRI at 6-8 weeks. We reviewed the DWI/ADC and FLAIR sequences in patients with recurrent stroke and characterized the number of infarcts, infarct location, size, and patterns based on whether they were borderzone (BZ), perforator (SC/P), cortical or territorial (C/T), and mixed. Temporal characteristics were delineated by ADC/FLAIR correlation. Results: Of the 89 patients with 6-8 weeks MRI, 22 (24.7%) had recurrent infarcts in the territory of the symptomatic artery. Recurrent infarcts were evident on DWI in 63.6% and single infarcts in 54.5%. The median recurrent infarct volume was 2.0 cm3 compared to median index infarct volumes of 2.5 cm3. A mixed infarct pattern was most common (40.9%), followed by borderzone (22.7%), cortical or territorial (27.3%), while only 9.1% were in a perforator artery distribution. Amongst those with a mixed pattern, 8/9 had a borderzone distribution infarct as part of their mixed infarct pattern. Conclusion: These findings provide novel data on the characteristics of early recurrent infarcts in patients with symptomatic ICAD.
Introduction: While much is known about recurrent clinical events in patients with intracranial atherosclerotic disease (ICAD), there is limited data on characteristics of recurrent infarcts. Methods: The NIH-funded MyRIAD prospective, observational study was designed to identify mechanisms of ischemia and predictors of recurrence in ICAD. Recurrent infarction was assessed on MRI at 6-8 weeks. We reviewed the DWI/ADC and FLAIR sequences in patients with recurrent stroke and characterized the number of infarcts, infarct location, size, and patterns based on whether they were borderzone (BZ), perforator (SC/P), cortical or territorial (C/T), and mixed. Temporal characteristics were delineated by ADC/FLAIR correlation. Results: Of the 89 patients with 6-8 weeks MRI, 22 (24.7%) had recurrent infarcts in the territory of the symptomatic artery. Recurrent infarcts were evident on DWI in 63.6% and single infarcts in 54.5%. The median recurrent infarct volume was 2.0 cm3 compared to median index infarct volumes of 2.5 cm3. A mixed infarct pattern was most common (40.9%), followed by borderzone (22.7%), cortical or territorial (27.3%), while only 9.1% were in a perforator artery distribution. Amongst those with a mixed pattern, 8/9 had a borderzone distribution infarct as part of their mixed infarct pattern. Conclusion: These findings provide novel data on the characteristics of early recurrent infarcts in patients with symptomatic ICAD.
Authors: T Wessels; C Wessels; A Ellsiepen; I Reuter; S Trittmacher; E Stolz; M Jauss Journal: AJNR Am J Neuroradiol Date: 2006-01 Impact factor: 3.825
Authors: Tanya N Turan; Michael J Lynn; Azhar Nizam; Bethany Lane; Brent M Egan; Ngoc-Anh Le; Maria F Lopes-Virella; Kathie L Hermayer; Oscar Benavente; Carole L White; W Virgil Brown; Michelle F Caskey; Meghan R Steiner; Nicole Vilardo; Andrew Stufflebean; Colin P Derdeyn; David Fiorella; Scott Janis; Marc I Chimowitz Journal: Circ Cardiovasc Qual Outcomes Date: 2012-09-01
Authors: Elena López-Cancio; Maria Gisele Matheus; Jose G Romano; David S Liebeskind; Shyam Prabhakaran; Tanya N Turan; George A Cotsonis; Michael J Lynn; Zoran Rumboldt; Marc I Chimowitz Journal: Cerebrovasc Dis Date: 2014-07-04 Impact factor: 2.762
Authors: Colin P Derdeyn; Marc I Chimowitz; Michael J Lynn; David Fiorella; Tanya N Turan; L Scott Janis; Jean Montgomery; Azhar Nizam; Bethany F Lane; Helmi L Lutsep; Stanley L Barnwell; Michael F Waters; Brian L Hoh; J Maurice Hourihane; Elad I Levy; Andrei V Alexandrov; Mark R Harrigan; David Chiu; Richard P Klucznik; Joni M Clark; Cameron G McDougall; Mark D Johnson; G Lee Pride; John R Lynch; Osama O Zaidat; Zoran Rumboldt; Harry J Cloft Journal: Lancet Date: 2013-10-26 Impact factor: 79.321
Authors: Negar Asdaghi; Lesly A Pearce; Makoto Nakajima; Thalia S Field; Carlos Bazan; Franco Cermeno; Leslie A McClure; David C Anderson; Robert G Hart; Oscar R Benavente Journal: Stroke Date: 2014-09-04 Impact factor: 7.914
Authors: Shyam Prabhakaran; David S Liebeskind; George Cotsonis; Azhar Nizam; Edward Feldmann; Rajbeer S Sangha; Iszet Campo-Bustillo; Jose G Romano Journal: J Stroke Cerebrovasc Dis Date: 2021-10-26 Impact factor: 2.136