Shyam Prabhakaran1, David S Liebeskind2, George Cotsonis3, Azhar Nizam3, Edward Feldmann4, Rajbeer S Sangha5, Iszet Campo-Bustillo6, Jose G Romano6. 1. Department of Neurology, The University of Chicago, IL (S.P.). 2. Department of Neurology, University of California at Los Angeles (D.S.L.). 3. Department of Bioinformatics and Biostatistics, Emory University, Atlanta, GA (G.C., A.N.). 4. Department of Neurology, The University of Massachusetts Medical School-Baystate, Springfield (E.F.). 5. Department of Neurology, University of Alabama at Birmingham (R.S.S.). 6. Department of Neurology, University of Miami, FL (I.C.-B., J.G.R.).
Abstract
BACKGROUND AND PURPOSE: While prior studies identified risk factors for recurrent stroke in patients with symptomatic intracranial atherosclerotic disease, few have assessed risk factors for early infarct recurrence. METHODS: We performed a post hoc analysis of the MYRIAD study (Mechanisms of Early Recurrence in Intracranial Atherosclerotic Disease) of intracranial atherosclerotic disease patients with recent (<21 days) stroke/transient ischemic attack, 50% to 99% stenosis and who underwent 6- to 8-week magnetic resonance imaging (MRI) per protocol. Infarct recurrence was defined as new infarcts in the territory of the symptomatic artery on brain MRI at 6 to 8 weeks compared to index brain MRI. Qualifying events and clinical and imaging outcomes were centrally ascertained by 2 independent reviewers. We assessed the association between baseline clinical and imaging variables and recurrent infarct in bivariate models and multivariable logistic regression to identify independent predictors of infarct recurrence. RESULTS: Of 105 enrolled patients in MYRIAD, 89 (84.8%) were included in this analysis (mean age, 64±12 years, 54 [60.7%] were male, and 53 [59.6%] were White). The median time from qualifying event to MRI was 51+16 days, on which 22 (24.7%) patients had new or recurrent infarcts. Younger age (57.7 versus 66.0 years; P<0.01), diabetes (32.6% versus 14.6%, P=0.05), index stroke (31.3% versus 4.6%, P=0.01), anterior circulation location of stenosis (29.7% versus 12.0%, P=0.08), number of diffusion-weighted imaging lesions (>1: 40.0%, 1: 26.9% versus 0: 4.4%, P<0.01), and borderzone infarct pattern (63.6% versus 25.0%, P=0.01) on baseline MRI were associated with new or recurrent infarcts. Age (adjusted odds ratio, 0.93 [95% CI, 0.89-0.98], P<0.01) and number of diffusion-weighted imaging lesions (adjusted odds ratio, 3.24 [95% CI, 1.36-7.71], P<0.01) were independently associated with recurrent infarct adjusting for hypertension, diabetes, and stenosis location (anterior versus posterior circulation). CONCLUSIONS: An index multi-infarct pattern is associated with early recurrent infarcts, a finding that might be explained by plaque instability and artery-to-artery embolism. Further investigation of plaque vulnerability in intracranial atherosclerotic disease is needed. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02121028.
BACKGROUND AND PURPOSE: While prior studies identified risk factors for recurrent stroke in patients with symptomatic intracranial atherosclerotic disease, few have assessed risk factors for early infarct recurrence. METHODS: We performed a post hoc analysis of the MYRIAD study (Mechanisms of Early Recurrence in Intracranial Atherosclerotic Disease) of intracranial atherosclerotic disease patients with recent (<21 days) stroke/transient ischemic attack, 50% to 99% stenosis and who underwent 6- to 8-week magnetic resonance imaging (MRI) per protocol. Infarct recurrence was defined as new infarcts in the territory of the symptomatic artery on brain MRI at 6 to 8 weeks compared to index brain MRI. Qualifying events and clinical and imaging outcomes were centrally ascertained by 2 independent reviewers. We assessed the association between baseline clinical and imaging variables and recurrent infarct in bivariate models and multivariable logistic regression to identify independent predictors of infarct recurrence. RESULTS: Of 105 enrolled patients in MYRIAD, 89 (84.8%) were included in this analysis (mean age, 64±12 years, 54 [60.7%] were male, and 53 [59.6%] were White). The median time from qualifying event to MRI was 51+16 days, on which 22 (24.7%) patients had new or recurrent infarcts. Younger age (57.7 versus 66.0 years; P<0.01), diabetes (32.6% versus 14.6%, P=0.05), index stroke (31.3% versus 4.6%, P=0.01), anterior circulation location of stenosis (29.7% versus 12.0%, P=0.08), number of diffusion-weighted imaging lesions (>1: 40.0%, 1: 26.9% versus 0: 4.4%, P<0.01), and borderzone infarct pattern (63.6% versus 25.0%, P=0.01) on baseline MRI were associated with new or recurrent infarcts. Age (adjusted odds ratio, 0.93 [95% CI, 0.89-0.98], P<0.01) and number of diffusion-weighted imaging lesions (adjusted odds ratio, 3.24 [95% CI, 1.36-7.71], P<0.01) were independently associated with recurrent infarct adjusting for hypertension, diabetes, and stenosis location (anterior versus posterior circulation). CONCLUSIONS: An index multi-infarct pattern is associated with early recurrent infarcts, a finding that might be explained by plaque instability and artery-to-artery embolism. Further investigation of plaque vulnerability in intracranial atherosclerotic disease is needed. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02121028.
Entities:
Keywords:
biomarkers; disease; hypertension; magnetic resonance imaging; risk factors
Authors: Shadi Yaghi; Pooja Khatri; Shyam Prabhakaran; Sharon D Yeatts; Shawna Cutting; Mahesh Jayaraman; Andrew D Chang; Daniel Sacchetti; David S Liebeskind; Karen L Furie Journal: J Neuroimaging Date: 2018-11-06 Impact factor: 2.486
Authors: Sepideh Amin-Hanjani; Dilip K Pandey; Linda Rose-Finnell; Xinjian Du; DeJuran Richardson; Keith R Thulborn; Mitchell S V Elkind; Gregory J Zipfel; David S Liebeskind; Frank L Silver; Scott E Kasner; Victor A Aletich; Louis R Caplan; Colin P Derdeyn; Philip B Gorelick; Fady T Charbel Journal: JAMA Neurol Date: 2016-02 Impact factor: 18.302
Authors: Hugh S Markus; Dirk W Droste; Manfred Kaps; Vincent Larrue; Kennedy R Lees; Mario Siebler; E Bernd Ringelstein Journal: Circulation Date: 2005-04-25 Impact factor: 29.690
Authors: Michael F Waters; Brian L Hoh; Michael J Lynn; Hyung-Min Kwon; Tanya N Turan; Colin P Derdeyn; David Fiorella; Anna Khanna; Tiffany O Sheehan; Bethany F Lane; Scott Janis; Jean Montgomery; Marc I Chimowitz Journal: JAMA Neurol Date: 2016-03 Impact factor: 18.302
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
Authors: Brian Mac Grory; Shadi Yaghi; Charlotte Cordonnier; Luciano A Sposato; Jose G Romano; Seemant Chaturvedi Journal: Circ Res Date: 2022-04-14 Impact factor: 23.213