Abstract 3094: Diffusion-Positive Cerebral Ischemia with Transient Symptoms - Is it Transient Ischemic Attack or Minor Ischemic Stroke? A Formal Analysis of Demographics, Risk Factors, and Prognosis

Background: The classification of patients with minor cerebral ischemic events is evolving. Under the classical time-based definition of TIA, cerebral infarcts with transient symptoms (CITS) were classified as TIA, while it is classified as minor ischemic stroke (MIS) under the modern tissue-based definition. However, arguments for this reclassification have been largely based on pathologic principles rather than formal analysis of whether CITS patients clinically more resemble DWI-negative TIA patients or MIS patients in demographics, clinical features, and prognosis. Methods: We analyzed consecutive patients recorded in a prospectively maintained database with symptoms of presumed focal ischemic origin either lasting less than 24 hours or with minor neurologic deficits (NIHSS≤5) lasting more than 24 hours. Patients had to present within 48 hours of symptom onset and have undergone acute DWI. Patients were excluded if ischemia occurred immediate after carotid endarterectomy or stenting. Clinical variables, ABCD 2 score, presence of DWI abnormality, relevant large artery disease (≥ 50% stenosis or occlusion of ipsilateral intracranial or extracranial vessels), and stroke recurrence within 90 days were recorded for analysis. Results: Among 416 patients meeting inclusion criteria (mean age 67 years, female 47.1%), 108 (26.0%) were CITS, 149 (35.8%) were DWI-negative TIA, and 159 (38.2%) were MIS. Compared with DWI-negative TIA patients, CITS patients were younger (65 vs. 70 years, p=0.017), had more coronary artery disease (25.9% vs. 14.1%, p=0.024) and relevant large artery disease (45.2% vs. 20.8%, p<0.001). In contrast, only diabetes differed between CITS and MIS patients (16.7% vs. 29.7%, p=0.027). The frequency of recurrent stroke was not different between MIS and CITS patients (16.0% vs. 12.3%, p>0.05), however, both were substantially higher than in DWI-negative TIA patients (2.5%). In multivariate logistic regression analysis performed across the entire cohort, the independent predictors of recurrent stroke were presence of DWI lesion (OR 4.95, 95% CI 1.11-22.09) and relevant large artery disease (OR 3.58, 95% CI 1.47-8.73). Conclusion: DWI-positive cerebral ischemia with transient symptoms more resembles MIS than DWI-negative TIA in risk factor profile and prognosis of patients. DWI abnormality and large artery disease, rather than clinical variables, are the predominant determinants of early stroke recurrence. These results emphasize the utility of urgent MR imaging in patients with minor cerebral ischemic episodes and support the rationale of tissue-based definition of TIA over time-based definition.

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A Nomogram for Predicting Stroke Recurrence Among Young Adults

Stroke ◽

10.1161/strokeaha.120.029740 ◽

2020 ◽

Vol 51 (6) ◽

pp. 1865-1867

Author(s):

Kang Yuan ◽

Jingjing Chen ◽

Pengfei Xu ◽

Xiaohao Zhang ◽

Xiuqun Gong ◽

...

Keyword(s):

Diabetes Mellitus ◽

Young Adults ◽

Ischemic Stroke ◽

High Risk ◽

Smoking Status ◽

Recurrent Stroke ◽

Risk Groups ◽

Risk Scores ◽

Stroke Recurrence ◽

Large Artery

Background and Purpose— This study aimed to develop and validate a nomogram for predicting the risk of stroke recurrence among young adults after ischemic stroke. Methods— Patients aged between 18 and 49 years with first-ever ischemic stroke were selected from the Nanjing Stroke Registry Program. A stepwise Cox proportional hazards regression model was employed to develop the best-fit nomogram. The discrimination and calibration in the training and validation cohorts were used to evaluate the nomogram. All patients were classified into low-, intermediate-, and high-risk groups based on the risk scores generated from the nomogram. Results— A total of 604 patients were enrolled in this study. Hypertension (hazard ratio [HR], 2.038 [95% CI, 1.504–3.942]; P =0.034), diabetes mellitus (HR, 3.224 [95% CI, 1.848–5.624]; P <0.001), smoking status (current smokers versus nonsmokers; HR, 2.491 [95% CI, 1.304–4.759]; P =0.006), and stroke cause (small-vessel occlusion versus large-artery atherosclerosis; HR, 0.325 [95% CI, 0.109–0.976]; P =0.045) were associated with recurrent stroke. Educational years (>12 versus 0–6; HR, 0.070 [95% CI, 0.015–0.319]; P =0.001) were inversely correlated with recurrent stroke. The nomogram was composed of these factors, and successfully stratified patients into low-, intermediate-, and high-risk groups ( P <0.001). Conclusions— The nomogram composed of hypertension, diabetes mellitus, smoking status, stroke cause, and education years may predict the risk of stroke recurrence among young adults after ischemic stroke.

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Sex differences in the risk of recurrent ischemic stroke after ischemic stroke and transient ischemic attack

European Stroke Journal ◽

10.1177/23969873211058568 ◽

2021 ◽

pp. 239698732110585

Author(s):

Elora Basu ◽

Setareh Salehi Omran ◽

Hooman Kamel ◽

Neal S Parikh

Keyword(s):

Risk Factors ◽

Sex Differences ◽

Ischemic Stroke ◽

Stroke Risk ◽

Recurrent Stroke ◽

Minor Stroke ◽

Stroke Recurrence ◽

Stroke Risk Factors ◽

Minor Ischemic Stroke ◽

Using Data

Background Sex differences in stroke outcomes have been noted, but whether this extends to stroke recurrence is unclear. We examined sex differences in recurrent stroke using data from the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial. Patients and methods We assessed the risk of recurrent stroke in women compared to men using data from the POINT trial. Adults >18 years old were randomized within 12 hours of onset of minor ischemic stroke or transient ischemic attack (TIA), and followed for up to 90 days for ischemic stroke, our primary outcome. We used Cox proportional hazards model adjusted for demographics and stroke risk factors to evaluate the association between sex and stroke recurrence. We used interaction term testing and prespecified subgroup analyses to determine if the association between sex and recurrent stroke differed by age (<60 versus >60 years old), locale (US versus non-US), and index event type (stroke versus TIA). Last, we evaluated whether sex modified the effect of common stroke risk factors on stroke recurrence. Results Of 4,881 POINT trial participants with minor stroke or high-risk TIA, 2,195 (45%) were women. During the 90-day follow-up period, 267 ischemic strokes occurred; 121 were in women and 146 in men. The cumulative risk of recurrent ischemic stroke was not significantly different among women (5.76%; 95% CI, 4.84%–6.85%) compared to men (5.67%; 95% CI, 4.83%–6.63%). Women were not at a different risk of recurrent ischemic stroke compared to men (hazard ratio [HR], 1.02; 95% CI, 0.80–1.30) in unadjusted models or after adjusting for covariates. However, there was a significant interaction of age with sex (P=0.04). Among patients <60 years old, there was a non-significantly lower risk of recurrent stroke in women compared to men (HR 0.66; 95% CI 0.42–1.05). Last, sex did not modify the association between common stroke risk factors and recurrent stroke risk. Discussion and Conclusion Among patients with minor stroke or TIA, the risk of recurrent ischemic stroke and the impact of common stroke risk factors did not differ between men and women.

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Cognitive and Behavioral Disorders in Patients with Precuneal Infarcts

European Neurology ◽

10.1159/000513098 ◽

2021 ◽

pp. 1-11

Author(s):

Emre Kumral ◽

Fatma Ece Bayam ◽

Hüseyin Nezih Özdemir

Keyword(s):

Ischemic Stroke ◽

Behavioral Disorders ◽

Cognitive Disorders ◽

Body Awareness ◽

Cognitive Disorder ◽

Behavioral Characteristics ◽

Large Artery ◽

Proper Definition ◽

Artery Disease ◽

Definition Of

Objective: Ischemic stroke of the precuneal cortex (PC) alone is extremely rare. This study aimed to evaluate the clinical, neurocognitive, and behavioral characteristics of isolated PC infarcts. Methods: We assessed neuropsychological and behavioral findings in 12 patients with isolated PC infarct among 3,800 patients with ischemic stroke. To determine the most frequently affected brain locus in patients, we first overlapped the ischemic area of patients with specific cognitive disorders and patients without specific cognitive disorders. Second, we compared both overlap maps using the “subtraction plot” function of MRIcroGL. Results: Patients showed various types of cognitive disorders. All patients experienced more than 1 category of cognitive disorder, except for 2 patients with only 1 cognitive disorder. Lesion topographical analysis showed that damage within the anterior precuneal region might lead to consciousness disorders (25%), self-processing impairment (42%), visuospatial disorders (58%), and lesions in the posterior precuneal region caused episodic and semantic memory impairment (33%). The whole precuneus is involved in at least one body awareness disorder. The cause of stroke was cardioembolism in 5 patients (42%), large artery disease in 3 (25%), and unknown in 4 (33%). Conclusions: This study showed a wide variety of neuropsychological and behavioral disorders in patients with precuneal infarct. Future studies are needed to achieve a proper definition of the function of the precuneus in relation to the extended cortical areas. PC region infarcts have been found to predict a source of embolism from the large arteries or heart.

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High five-year mortality rates of ischemic stroke subtypes: A prospective cohort study in Brazil

International Journal of Stroke ◽

10.1177/1747493018806197 ◽

2018 ◽

Vol 14 (5) ◽

pp. 491-499 ◽

Cited By ~ 4

Author(s):

Norberto Luiz Cabral ◽

Vivian Nagel ◽

Adriana B Conforto ◽

Pedro SC Magalhaes ◽

Vanessa G Venancio ◽

...

Keyword(s):

Ischemic Stroke ◽

Survival Probability ◽

Recurrent Stroke ◽

Mortality Rates ◽

Large Artery ◽

Small Artery ◽

Stroke Patients ◽

Stroke Subtypes ◽

Artery Disease

Background Studies regarding long-term outcomes of ischemic stroke subtypes are scarce in low- and middle-income countries. We aimed to measure the five-year prognosis of ischemic stroke subtypes in Joinville, Brazil. Methods All first-ever ischemic strokes that occurred in Joinville in 2010 were followed-up for five years. Results We included 334 ischemic stroke patients. Over five years, 156 died, 51 had a recurrent stroke, and 128 were free of recurrent stroke. The overall cumulative risk of death was 17% (95% CI, 13% to 22%) at 30 days and 47% (95% CI, 41% to 52%) after five years. Undetermined with incomplete investigation ischemic stroke had a significantly worse survival probability (β −4.91; 95% CI, −6.31 to −3.50; p < 0.001), followed by cardioembolic ischemic stroke (β −3.07; 95% CI, −4.32 to −1.83; p < 0.001) and large artery disease ischemic stroke (β −1.95; 95% CI, −3.30 to −0.60; p = 0.005). The survival probability of undetermined with negative investigation or cryptogenic ischemic stroke did not differ significantly from small artery disease ischemic stroke (β −1.022; 95% CI, −3.37 to −1.43; p = 0.414). The five-year mortality for small artery disease ischemic stroke was 30% (95% CI, 22% to 39%) and 47% (95% CI, 35% to 60%) for large artery ischemic stroke. The risk of stroke recurrence was 2% in the first year and 5% in the second year. The proportion of disability among survivors in the first month ranged from 8% (95% CI, 3–15) for small artery disease ischemic stroke to 40% (95% CI, 30–52) for cardioembolic ischemic stroke patients. Conclusions Cardioembolic and undetermined with incomplete investigation ischemic stroke sub-types have a poor long-term prognosis. An alarming finding was that our patients with both small and large artery ischemic stroke had higher five-year mortality rates compared with subjects from high-income countries.

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EXPRESS: Evolving Ischemic Stroke Subtypes in 15 years: A hospital-based observational study

International Journal of Stroke ◽

10.1177/17474930211005953 ◽

2021 ◽

pp. 174749302110059

Author(s):

Yiu Ming Bonaventure Ip ◽

Lisa Au ◽

Yin Yan Anne Chan ◽

Florence Fan ◽

Hing Lung Ip ◽

...

Keyword(s):

Ischemic Stroke ◽

Recurrence Rate ◽

Small Vessel Disease ◽

Mainland China ◽

Cardioembolic Stroke ◽

Large Artery ◽

Risk Factor Control ◽

Stroke Subtypes ◽

Artery Disease ◽

Ischemic Attack

Background: Depicting the time trends of ischemic stroke subtypes may inform healthcare resource allocation on etiology-based stroke prevention and treatment. Aim: To reveal the evolving ischemic stroke subtypes from 2004 to 2018. Methods: We determined the stroke etiology of consecutive first-ever transient ischemic attack or ischemic stroke patients admitted to a regional hospital in Hong Kong from 2004 to 2018. We analyzed the age-standardized incidences and the 2-year recurrence rate of major ischemic stroke subtypes. Results: Among 6940 patients admitted from 2004 to 2018, age-standardized incidence of ischemic stroke declined from 187.0 to 127.4 per 100,000 population (p<0.001), driven by the decrease in large artery disease (43.0 to 9.67 per 100,000 population (p<0.001)) and small vessel disease (71.9 to 45.7 per 100,000 population (p<0.001)). Age-standardized incidence of cardioembolic stroke did not change significantly (p=0.2). Proportion of cardioembolic stroke increased from 20.4% in 2004-2006 to 29.3% in 2016-2018 (p<0.001). 2-year recurrence rate of intracranial atherothrombotic stroke reduced from 19.3% to 5.1% (p<0.001) with increased prescriptions of statin (p<0.001) and dual anti-platelet therapy (<0.001). In parallel with increased anticoagulation use across the study period (p<0.001), the 2-year recurrence of AF-related stroke reduced from 18.9% to 6% (p<0.001). Conclusion: Etiology-based risk factor control might have led to the diminishing stroke incidences related to atherosclerosis. To tackle the surge of AF-related strokes, arrhythmia screening, anticoagulation usage and mechanical thrombectomy service should be reinforced. Comparable preventive strategies might alleviate the enormous stroke burden in mainland China.

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2014 Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack

International Journal of Stroke ◽

10.1177/1747493017694391 ◽

2017 ◽

Vol 12 (3) ◽

pp. 302-320 ◽

Cited By ~ 24

Author(s):

Yongjun Wang ◽

Ming Liu ◽

Chuanqiang Pu

Keyword(s):

Ischemic Stroke ◽

Secondary Prevention ◽

Transient Ischemic Attack ◽

Recurrent Stroke ◽

Stroke Recurrence ◽

Evidence Based ◽

Cerebrovascular Disorder ◽

Level Of Evidence ◽

Vascular Stenosis ◽

Ischemic Attack

Ischemic stroke and transient ischemic attack (TIA) are the most common cerebrovascular disorder and leading cause of death in China. The Effective secondary prevention is the vital strategy for reducing stroke recurrence. The aim of this guideline is to provide the most updated evidence-based recommendation to clinical physicians from the prior version. Control of risk factors, intervention for vascular stenosis/occlusion, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke are all recommended, and the prevention of recurrent stroke in a variety of uncommon causes and subtype provided as well. We modified the level of evidence and recommendation according to part of results from domestic RCT in order to facility the clinical practice.

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Abstract TP41: Prevalence and Factors Associated with Early Ischemic Changes on Non-contrast CT Obtained Less Than 90 Minutes After Symptom Onset

Stroke ◽

10.1161/str.48.suppl_1.tp41 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Jared Noroozi ◽

David S Liebeskind ◽

Jeffrey L Saver ◽

Sidney Starkman ◽

Juan Pablo Villablanca ◽

...

Keyword(s):

Ischemic Stroke ◽

Cerebral Ischemia ◽

Symptom Onset ◽

Clinical Information ◽

Final Diagnosis ◽

Factors Associated ◽

History Of ◽

Artery Disease ◽

Initial Imaging ◽

Contrast Ct

Background: Usually early infarct signs on imaging take a few hours to develop in ischemic stroke. There may be a subset of patients manifesting early infarct signs on imaging hyperacutely. Objective: To determine the prevalence and factors associated with very early infarct signs on ASPECTS among patients with cerebral ischemia who were imaged <90 minutes after symptom onset. Methods: Subjects participating in the NIH Field Administration of Stroke Therapy- Magnesium (FAST-MAG) phase 3 clinical trial with a final diagnosis of cerebral ischemia (TIA or Stroke) and initial imaging performed <90 minutes from last known well time (LKWT) were included. ASPECTS was graded by a neuroradiologist (JPV) blinded to all clinical information. Individual subjects were characterized as having no early ischemic changes (ASPECTS 10) vs. early ischemic changes (ASPECTS 0-9). We describe the prevalence of early ischemic signs in this prospectively enrolled cohort, clinical factors associated with early ischemic changes as well as outcomes. Results: There were 566 cases imaged a mean of 71 (SD 11) minutes after LKWT. Mean age was 69 (SD 13), 43% women, 93% ischemic stroke, 7% TIA, median emergency department NIHSS 8 (IQR 3-16), median ASPECTS score of 10 (IQR 7-10, range 1-10). There were 200 cases with early ischemic findings (35%). Early ischemic changes were not related to age, blood pressure, history of hypertension, diabetes, dyslipidemia, coronary artery disease, or time to imaging (71 vs. 71 mins). Early ischemic changes were more commonly noted in women (50% vs. 39%, p=0.015) and associated higher presenting NIHSS (14 [IQR 7-20] vs 5 [IQR 2-11], p<0.001). The presence of any hyperacute ischemia change was associate with worse 90-day outcome (modified Rankin score 3 [IQR 1-5] vs 1 [IQR 0-3, p<0.001). Conclusions: Early ischemic changes were noted on about 1/3 rd of imaging obtained <90 minutes after symptom onset. The presence of hyperacute ischemic changes is associated with more severe stroke and poor clinical outcomes.

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Abstract 181: Determinants of Intracranial Atherosclerotic Enhancement on Vessel Wall MRI in Patients with Acute Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.181 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Adam de Havenon ◽

Nabeel Chauhan ◽

Jennifer Majersik ◽

David Tirschwell ◽

Ka-Ho Wong ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Vessel Wall ◽

Recurrent Stroke ◽

Pulse Sequences ◽

High Rate ◽

Stroke Recurrence ◽

Anterior Circulation ◽

Post Contrast

Introduction: Enhancing intracranial atherosclerotic plaque on high-resolution vessel wall MRI (vwMRI) is a reliable marker of recent thromboembolism, and confers a recurrent stroke risk of up to 30% a year. Post-contrast plaque enhancement (PPE) on vwMRI is thought to represent inflammation, but studies have not fully examined the clinical, serologic or radiologic factors that contribute to PPE. Methods: Inpatients with acute ischemic stroke due to intracranial atherosclerosis were prospectively enrolled at a single center from 2015-16. vwMRI was performed on a 3T Siemens Verio and included 3D DANTE pulse sequences, pre- and post-contrast (for PPE identification). Three experienced neuroradiologists interpreted vwMRI using a validated multicontrast technique. The Chi-squared, Fisher’s Exact, and Student’s t-test were used for intergroup differences, and logistic regression was fitted to the primary outcome of PPE. Results: Inclusion criteria were met by 35 patients. Atherosclerotic plaques were in the anterior circulation in 21/35 (60%) and PPE was diagnosed in 20/35 (57%) of stroke parent arteries. PPE predictors are shown in Table 1 with logistic regression in Table 2 . Conclusion: PPE is associated with stenosis, which was expected, but the association with HgbA1c is novel. All patients with HgbA1c >8 had PPE and a one point HgbA1c rise increased the odds of PPE 3-fold. Hyperglycemia induces vascular oxidative stress by generating reactive oxygen species, quenching nitric oxide, and triggering an inflammatory cascade. Given the high rate of stroke recurrence in PPE patients, aggressive HgbA1c reduction may be a viable treatment target and warrants additional study.

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Abstract TP416: Comparative Effectiveness of Addition of Antiplatelet to Oral Anticoagulant in Acute Ischemic Stroke With Atrial Fibrillation

Stroke ◽

10.1161/str.51.suppl_1.tp416 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Joon-tae Kim ◽

Hee-Joon Bae ◽

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Oral Anticoagulant ◽

Recurrent Stroke ◽

Cox Proportional Hazards ◽

Large Artery ◽

Vascular Events ◽

Nihss Score ◽

Composite Events

Introduction: Atrial fibrillation (AF) and large artery diseases (LAD) share several risk factors and often coexist in the same patient. Optimal treatments for acute ischemic stroke (AIS) patients with concomitant AF and LAD have not been extensively studied so far. Objective: This study aimed to compare the effectiveness of the addition of antiplatelet (AP) to oral anticoagulant (OAC) with that of OAC alone in AIS with AF according to the LAD. Methods: Using a multicenter stroke registry, acute (within 48h of onset) and mild-to-moderate (NIHSS score ≤15) stroke patients with AF were identified. Propensity scores using IPTW were used to adjust baseline imbalances between the OAC+AP group and the OAC alone group in all patients and in each subgroup by LAD. The primary outcome was major vascular events, defined as the composite of recurrent stroke, MI, and all-cause mortality at up to 3 months after index stroke. Results: Among the 5469 patients (age, 72±10yrs; male, 54.9%; initial NIHSS score, 4 [2-9]), 79.0% (n=4323) received OAC alone, and 21.0% (n=1146) received OAC+AP. By weighted Cox proportional hazards analysis, a tendency of increasing the risk of 3-months primary composite events in the OAC+AP group vs the OAC alone (HR 1.36 [0.99-1.87], p=0.06), with significant interaction with treatments and LAD (Pint=0.048). Briefly, among patients with moderate-to-severe large artery stenosis, tendency of decrease in 3-months primary composite events of the OAC+AP group, compared with OAC alone group, was observed (HR 0.54 [0.17-1.70]), whereas among patients with complete occlusion, the OAC+AP group markedly increased the risk of 3-months composite events (HR 2.00 [1.27-3.15]), compared with the OAC alone group. No interaction between direct oral anticoagulant and warfarin on outcome was observed (Pint=0.35). Conclusion: In conclusion, treatment with addition of AP to OAC had a tendency to increase the risk of 3-months vascular events, compared with OAC alone in AIS with AF. However, the effects of antithrombotic treatment could be modified according to the LAD, with substantial benefits of OAC alone in subgroup of large artery occlusion. Our results address the need for the further study to tailor the optimal treatment in AIS with concomitant AF and LAD.

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Abstract TP438: Japanese versus Non-Japanese Patients With Transient Ischemic Attack or Minor Stroke: Five-Year Risk of Stroke and Vascular Events

Stroke ◽

10.1161/str.51.suppl_1.tp438 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Shinichiro Uchiyama ◽

Takao Hoshino ◽

Hugo Charles ◽

Kenji Kamiyama ◽

Taizen Nakase ◽

...

Keyword(s):

Intracranial Hemorrhage ◽

Transient Ischemic Attack ◽

Japanese Patients ◽

Minor Stroke ◽

Stroke Recurrence ◽

Large Artery ◽

Vascular Events ◽

Minor Ischemic Stroke ◽

Ischemic Attack

Background: We have reported 5-year risk of stroke and vascular events after a transient ischemic attack (TIA) or minor ischemic stroke in patients enrolled into the TIAregistry.org, which was an international multicenter-cooperative, prospective registry (N Engl J Med 2018;378:2182-90). We conducted subanalysis on the 5-year follow-up data of Japanese patients in comparison with non-Japanese patients. Methods: The patients were classified into two groups on ethnicity, Japanese (n=345) and non-Japanese (n=3502), and their 5-year event rates were compared. We also determined predictors of five-year stroke in both groups. Results: Death from vascular cause (0.9% vs 2.7%, HR 0.28, 95% CI 0.09-0.89, p=0.031) and death from any cause (7.8% vs 9.9%, HR 0.67, 95% CI 0.45-0.99, p=0.045) were fewer in Japanese patients than in non-Japanese patients, while stroke (13.9% vs 7.2%, HR 1.78, 95% CI 1.31-2.43, p<0.001) and intracranial hemorrhage (3.2% vs 0.8%, HR 3.61. 95% CI 1.78-7.30, p<0.001) were more common in Japanese than non-Japanese patients during five-year follow-up period. Caplan-Meyer curves at five-years showed that the rates of stroke was also significantly higher in Japanese than non-Japanese patients (log-rank test, p=0.001). Predictors for stroke recurrence at five years were large artery atherosclerosis (HR 1.81, 95% CI 1.31-2.52, p<0.001), cardioembolism (HR 1.71, 95% CI 1.18-2.47, p=0.004), multiple acute infarction (HR 1.77, 95% CI 1.27-2.45, p<0.001) and ABCD 2 score 6 or 7 (HR 1.96, 95% CI 1.38-2.78, p<0.001) in non-Japanese patients, although only large artery atherosclerosis (HR 3.28, 95% CI 1.13-9.54, p=0.029) was a predictor for stroke recurrence in Japanese patients. Conclusions: Recurrence of stroke and intracranial hemorrhage were more prevalent in Japanese than non-Japanese patients. Large artery atherosclerosis was a predictor for stroke recurrence not only in non-Japanese patients but also in Japanese patients.

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