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Hypoperfusion Distal to Anterior Circulation Intracranial Atherosclerosis is Associated with Recurrent Stroke
Author(s) -
Have Adam,
Khatri Pooja,
Prabhakaran Shyam,
Yeatts Sharon D,
Peterson Cecilia,
Sacchetti Daniel,
Alexander Matthew,
Cutting Shawna,
Grory Brian Mac,
Furie Karen,
Liebeskind David S,
Yaghi Shadi
Publication year - 2020
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/jon.12710
Subject(s) - medicine , icad , stroke (engine) , stenosis , perfusion , cardiology , perfusion scanning , hazard ratio , radiology , magnetic resonance imaging , middle cerebral artery , ischemia , confidence interval , mechanical engineering , biochemistry , chemistry , engineering , gene
BACKGROUND AND PURPOSE In patients with symptomatic vertebrobasilar intracranial atherosclerotic disease (ICAD), impaired distal flow predicts recurrent stroke, but limited data exist on the association between perfusion status and recurrent stroke in anterior circulation ICAD. METHODS This is a retrospective study of patients hospitalized for symptomatic ICAD with 50‐99% stenosis of the intracranial carotid or middle cerebral artery. The primary outcome is recurrent symptomatic ischemic stroke in the territory of the artery with ≥50% stenosis within 90 days. The primary predictor is distal hypoperfusion on magnetic resonance (MR) or computed tomography (CT) perfusion, defined as a ≥15 mL volume of territory of the symptomatic artery with T max >6 seconds. RESULTS Fifty patients met inclusion criteria, including 15 (30%) with recurrent stroke and 15 (30%) with distal hypoperfusion. Distal hypoperfusion was present in 10 of 15 (66.7%) with recurrent stroke versus 5 of 35 (14.3%) without recurrent stroke ( P < .001). The hazard ratio for recurrent stroke in patients with distal hypoperfusion was 6.80 (95% confidence interval [CI] 2.31‐20.0). CONCLUSION Distal hypoperfusion in acutely symptomatic ICAD with 50‐99% stenosis is associated with stroke recurrence. Distal hypoperfusion could be used to enrich future trials of secondary stroke prevention in ICAD patients.