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Early ischemic lesion recurrence within a week after acute ischemic stroke
Author(s) -
Kang DongWha,
Latour Lawrence L.,
Chalela Julio A.,
Dambrosia James,
Warach Steven
Publication year - 2003
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.10592
Subject(s) - lesion , medicine , hazard ratio , stroke (engine) , confidence interval , ischemia , ischemic stroke , penumbra , radiology , brain ischemia , cardiology , surgery , mechanical engineering , engineering
Previous observations suggested that multiple ischemic lesions on diffusion‐weighted imaging (DWI) are common in acute stroke patients. We hypothesized that a source of these multiple lesions was the recurrence of ischemic lesions within a week after a clinically symptomatic stroke. We analyzed 99 acute ischemic stroke patients scanned within 6 hours of onset and at subsequent times within the first week. Ischemic lesion recurrence was defined as any new lesion separate from the index lesion. Recurrent lesions occurring outside initial perfusion deficit were termed ‘distant lesion recurrence’. We estimated the hazard ratio (HR) of recurrence associated with clinical and imaging characteristics using log‐rank test. Any lesion recurrence was found in 34%, with distant lesion recurrence in 15%, while clinical recurrence was evident in 2%. Initial multiple DWI lesions were associated with any lesion recurrence (HR, 2.83; 95% confidence interval [CI], 1.65–10.29; p = 0.002) and with distant lesion recurrence (HR, 5.99; 95% CI, 4.05–64.07; p < 0.0001). Large‐artery atherosclerosis was the most frequent stroke subtype associated with any lesion recurrence ( p = 0.026). These results may indicate a prolonged state of increased ischemic risk over the first week and suggest DWI as a possible surrogate measure for recurrent stroke. Ann Neurol 2003