Abstract WP499: Cognitive Function in Patients With Symptomatic Intracranial Stenosis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Shyam Prabhakaran ◽  
Rajbeer Sangha ◽  
Sameer Ansari ◽  
PN Sylaja ◽  
David S Liebeskind ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Recurrent Stroke ◽  
Strong Predictor ◽  
Single Center ◽  
Nihss Score ◽  
T Score ◽  
Intracranial Atherosclerotic Disease ◽  
Imaging Characteristics ◽  
The Mean

Introduction: Compared to recurrent stroke risk, data are scarce on cognitive outcomes in patients with symptomatic intracranial atherosclerotic disease (ICAD). We evaluated cognition in patients with symptomatic ICAD at 90 days and factors that predict cognitive function. Methods: Using a prospective registry at a single center, we identified consecutive patients admitted between 2012 and 2017 with confirmed ischemic stroke or transient ischemic attack (TIA) and independently adjudicated symptomatic ICAD with stenosis of >50%. A blinded rater assessed infarct pattern: single perforator, territorial, borderzone, or mixed. At 90 days post-stroke, patients or proxies were emailed Neuro-QOL surveys for cognitive and motor function. We also collected data on recurrent stroke in the territory of the stenosis within 3 months. We evaluated baseline and imaging predictors of 90-day cognition T-score using stepwise linear regression adjusting for age, sex, prior stroke, initial NIHSS score, location of stenosis, degree of stenosis, use of dual antiplatelet therapy at discharge, and recurrent stroke. Results: Among 212 patients who met study criteria, 125 (59.0%) completed cognition surveys; those who completed surveys were similar to those who did not across demographic, clinical, and imaging characteristics. In the analyzed cohort, the mean age was 68.3 (±12.6) years and median initial NIHSS score was 3 (interquartile range 1-6). Symptomatic ICAD was localized to the anterior circulation in 84 (67.2%) patients and 102 (81.6%) had stenosis >70%. At 90 days, the mean cognition T-score was 50.1 (±10.4) and 25 (20%) had scores <40. In adjusted analysis, increasing age (b=-0.15, p=0.031), higher initial NIHSS score (b=-0.69, p<0.001), and a mixed or territorial infarct pattern (b=-0.39, p=0.028) were associated with lower cognition T-scores. Conclusions: In a single-center observational cohort study, cognitive impairment was noted in 20% of patients with symptomatic ICAD at 3 months. Besides age and NIHSS score, baseline infarct pattern was a strong predictor of worse cognitive function. Our data suggest that cognitive impairment is common in patients with symptomatic ICAD and baseline clinical and imaging characteristics may identify those at risk.

Abstract WMP45: Borderzone Infarct Pattern Predicts Recurrent Stroke in Patients With Intracranial Stenosis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Shyam Prabhakaran ◽  
Rajbeer Sangha ◽  
Sameer Ansari ◽  
Jose Romano ◽  
PN Sylaja ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Recurrent Stroke ◽  
Strong Predictor ◽  
Single Center ◽  
Anterior Circulation ◽  
Nihss Score ◽  
Intracranial Atherosclerotic Disease ◽  
Index Stroke ◽  
Ischemic Attack ◽  
Mixed Pattern

Introduction: Despite aggressive medical management, patients with symptomatic intracranial atherosclerotic disease (ICAD) remain at high risk for recurrent stroke. There are no reliable biomarkers to identify those at highest risk and in whom flow restorative procedures may be warranted. We hypothesized that a borderzone infarct pattern would predict 90-day recurrent stroke in the territory of symptomatic ICAD. Methods: Using the prospective registry at a single center, we identified consecutive patients admitted between 2012 and 2017 with confirmed ischemic stroke or transient ischemic attack (TIA) and independently adjudicated symptomatic ICAD with stenosis of >50%. We ascertained clinical events within 3 months of index stroke through telephone interview. Ischemic stroke in the territory of the symptomatic stenotic artery was the primary outcome. A blinded rater assessed infarct pattern: single perforator, territorial, borderzone, or mixed. We evaluated whether infarct pattern was a predictor of recurrent stroke using logistic regression adjusting for age, sex, prior stroke, initial NIHSS score, location of stenosis, degree of stenosis, and use of dual antiplatelet therapy at discharge. Results: Among 212 patients who met study criteria, the mean age was 68.2 (±12.2) years and median initial NIHSS score was 3 (interquartile range 1-6). Symptomatic ICAD was localized to the anterior circulation in 132 (64.2%) patients and 171 (80.7%) had stenosis >70%. Isolated borderzone infarcts were noted in 18 patients (8.5%) while they were present in 34 (16.0%) other patients with mixed pattern. At 3 months, 51 (24.1%) patients experienced recurrent stroke in the territory. Among patients with any borderzone infarct, 20 (38.7%) had recurrent stroke versus 31 (19.4%) in patients with other patterns (p=0.005). In adjusted analysis, presence of any borderzone infarct was independently associated with recurrent stroke (aOR 2.59, 95% CI 1.23-5.48, p=0.012). Conclusions: In a single-center observational cohort study, we found that a borderzone infarct pattern was a strong predictor of recurrent stroke at 3 months in patients with symptomatic ICAD. Our data suggest that hypoperfusion may be an important mechanism of recurrent stroke in this population.

scholarly journals Nithsdale Schizophrenia Surveys 20

2000 ◽  
Vol 177 (4) ◽  
pp. 348-353 ◽  
Author(s):  
C. Kelly ◽  
V. Sharkey ◽  
G. Morrison ◽  
J. Allardyce ◽  
R. G. McCreadie
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Cognitive Deficits ◽  
Verbal Fluency ◽  
Mini Mental State Examination ◽  
Community Based ◽  
Adult Reading ◽  
The Mean ◽  
National Adult Reading Test ◽  
State Examination

BackgroundCognitive deficits are a core aspect of schizophrenia but there has been no study of cognitive function in a catchment-area-based population of patients with schizophrenia.AimsTo assess cognitive function in a population of patients with schizophrenia, and relate it to community functioning.MethodAll patients with schizophrenia in Nithsdale, south-west Scotland, were identified (n=182). Measures of assessment were: National Adult Reading Test (NART), Mini-Mental State Examination (MMSE), Rivermead Behavioural Memory Test (RBMT), Executive Interview (EXIT), FAS Verbal Fluency and Health of the Nation Outcome Scales (HoNOS).ResultsWe assessed 138 patients, mean age 48 years (standard deviation (s.d.) 15). Only 14% were in-patients. The mean premorbid IQ as assessed by NART was 98 (s.d. 14); 15% of patients had significant global cognitive impairment (MMSE); 81% had impaired memory (RBMT); 25% had executive dyscontrol (EXIT); and 49% had impaired verbal fluency (FAS). Scores on the functional impairment sub-scale of HoNOS correlated with all measures of cognitive impairment.ConclusionsCognitive dysfunction is pervasive in a community-based population of patients with schizophrenia.

Impact of Baseline Features and Risk Factor Control on Cognitive Function in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial

2019 ◽  
Vol 47 (1-2) ◽  
pp. 24-31 ◽  
Author(s):  
Tanya N. Turan ◽  
Sami Al Kasab ◽  
Alison Smock ◽  
George Cotsonis ◽  
David Bachman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Medical Management ◽  
Physical Inactivity ◽  
Recurrent Stroke ◽  
Older Age ◽  
Aggressive Medical Management

Background: Cerebrovascular disease is an important cause of cognitive impairment. The aim of this study is to report the relationship between cognitive function and risk factors at baseline and during follow-up in the Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) trial. Methods: Subjects in the SAMMPRIS trial were included in this study. In order to have an assessment of cognitive function independent of stroke, patients with a stroke as a qualifying event whose deficits included aphasia or neglect were excluded from these analyses as were those with a cerebrovascular event during follow-up. The Montreal Cognitive Assessment (MoCA) score was used to assess cognitive impairment at baseline, 4 months, 12 months and closeout. Cognitive impairment was defined as MoCA < 26. A multivariate analysis was performed to determine what risk factors were independent predictors of cognitive function at baseline, 12 months and closeout. Among patients randomized to aggressive medical management only, the percentage of patients with cognitive impairment was compared between patients in versus out of target for each risk factor at 12 months and closeout. Results: Of the 451 patients in SAMMPRIS, 371 patients met the inclusion criteria. MoCA < 26 was present in 55% at baseline. Older age and physical inactivity were associated with cognitive impairment at baseline. Older age, non-white race, lower baseline body mass index, and baseline cognitive impairment were associated with cognitive impairment at 12 months. In the aggressive medical management group, at 12 months, physical inactivity during follow-up was the strongest risk factor associated with cognitive impairment. Conclusion: Cognitive impairment is common in patients with severe symptomatic intracranial atherosclerosis. Physical inactivity at baseline and during follow-up is a strong predictor of cognitive impairment.

scholarly journals Renal dysfunction is associated with decline of cognitive function in community-dwelling older adults: Korean frailty and aging cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ji Yoon Kong ◽  
Jin Sug Kim ◽  
Min Hye Kang ◽  
Hyeon Seok Hwang ◽  
Chang Won Won ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Renal Dysfunction ◽  
Elderly Population ◽  
Word List ◽  
Community Dwelling ◽  
Global Cognitive Function ◽  
The Mean

Abstract Background Cognitive decline is common in older adults. Similarly, the prevalence of renal dysfunction is also increased in the elderly population. We conducted this study to clarify the relationship between renal dysfunction and decline of cognitive function in community-dwelling elderly population. Methods A cross-sectional analysis was performed using data from the Korean Frailty and Aging Cohort Study, a nationwide cohort study. Total 2847 (1333 men, 1514 women) eligible participants were enrolled for this study. The estimated glomerular filtration rate (eGFR, mL/min/1.73m2) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Global cognitive function was assessed with the Mini-mental State Examination-Korean version. Other domains of cognitive function were tested with the Consortium to Establish a Registry for Alzheimer’s disease and the Frontal Assessment Battery. Results The mean age of all participants was 76.0 ± 3.9 years and eGFR (all in mL/min/1.73 m2) was 77.5 ± 14.3. And the mean eGFR was 91.7 ± 3.2 in quartile 1, 84.9 ± 1.8 in quartile 2, 76.1 ± 3.7 in quartile 3, and 57.2 ± 10.8 in quartile 4. In baseline characteristics, participants with lower eGFR tend to have lower cognitive function scores than participant with higher eGFR. In linear regression analysis, eGFR was correlated with the word list memory (β = 0.53, P = 0.005), word list recall (β = 0.86, P < 0.001), and word list recognition (β = 0.43, P = 0.030) after adjustment of confounding variables. Moreover, after multivariate adjustment the association with cognitive impairment in quartile 2 was stronger (adjusted OR: 1.535, 95% CI: 1.111–2.120, P = 0.009), and the ORs of cognitive impairment were 1.501 (95% CI: 1.084–2.079, P = 0.014) in quartile 3 and 1.423 (95% CI: 1.022–1.983, P = 0.037) in quartile 4. Conclusion In older adults, the immediate, recent memory, and recognition domains were significantly related to renal function. Also, the mild renal dysfunction was independently associated with impairment of global cognitive function. These results suggest that the early stages of renal dysfunction could be an effective target to prevent worsening of cognitive impairment. Therefore, regular monitoring and early detection of mild renal dysfunction in elderly population might be needed.

scholarly journals COMPARISON OF COGNITIVE FUNCTION BETWEEN FIRST ISCHEMIC STROKE AND RECURRENT ISCHEMIC STROKE PATIENTS

2022 ◽  
Vol 8 (1) ◽  
pp. 30-34
Author(s):  
Fildza Intan Rizkia ◽  
Chandra Calista ◽  
Suryani Gunadharma ◽  
Asep Nugraha Hermawan ◽  
Lisda Amalia ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Recurrent Stroke ◽  
Demographic Data ◽  
P Value ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Significant Difference ◽  
Stroke Group

Background: Cognitive impairment is a common condition that may affect up to 50% of stroke patients. Post stroke cognitive impairment is associated with reduced quality of life, which may increase the number of dependency. Recurrent stroke may happen in approximately 25% patients and they have higher rates of cognitive impairment. Objective: The aim of this study is to examine the comparison of cognitive function between first ischemic stroke and recurrent ischemic stroke patients in Hasan Sadikin Hospital, Bandung. Methods: This study is a retrospective, cross-sectional study using the data recruited between the year 2012 - 2016 at the Department of Neurology at the Hasan Sadikin Hospital Bandung. The data collected in this study were demographic data, including age, level of education, and residence, and the clinical data as well. Cognitive function was assessed using Mini-Mental State Examination (MMSE). The comparison between the cognitive function between both groups were analyzed using the Mann-Whitney U test. Results: There were 428 subjects eligible for this study, with 207 subjects categorized as first ischemic stroke group and 221 subjects categorized as recurrent ischemic stroke group. There was a statistically significant difference in MMSE scores between the first ischemic stroke patients (24.90 ± 4.64) and recurrent ischemic stroke patients (22.85 ± 4.64 ) with a p value of 0.002. Conclusion: Recurrent ischemic stroke patients had lower MMSE scores than the first ischemic stroke patients. Clinicians should be more aware in detecting early cognitive impairment in stroke patients and in preventing the incidence of recurrent stroke.

scholarly journals Cognitive dysfunction among inpatients and outpatients with schizophrenia: relationship to positive and negative symptoms

2020 ◽  
Vol 27 (1) ◽  
Author(s):  
Tarek Ahmed Okasha ◽  
Hanan Hussein ◽  
Eman Shorub ◽  
Hamed Nagi ◽  
Ahmed A. Moustafa ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Executive Function ◽  
Cognitive Function ◽  
Negative Symptoms ◽  
Strong Predictor ◽  
Structured Interview ◽  
Wisconsin Card Sorting Test ◽  
Assessment Tools ◽  
Influential Factor ◽  
Significant Difference

Abstract Background Cognitive impairment is an established feature of schizophrenia and is a strong predictor of eventual social and functional outcome. Few studies have investigated cognitive impairment in hospital long-stay patients with schizophrenia. This study evaluates and compares cognitive function among a sample of patients with schizophrenia in both inpatient and outpatient departments in order to determine the relationship between cognitive impairment and clinical variables. A cross-sectional comparative study based on a semi-structured interview investigating 100 inpatients with schizophrenia recruited from El-Abassia Mental Health Hospital departments compared to 100 patients with schizophrenia selected from the outpatients’ clinic matched with cases. The assessment tools included SCID-I, the Adult Wechsler Intelligence Scale, the computerized version of Wisconsin Card Sorting Test (WCST), Mini-Mental State Examination (MMSE), and Positive and Negative Syndrome Scale (PANSS). Results Patients with schizophrenia showed significant deficits on cognitive function with no statistically significant difference between the inpatient and outpatient groups. Executive function was significantly correlated with verbal, non-verbal, and total IQ. Executive function was negatively correlated with the positive and general symptoms of PANSS and not correlated with its negative symptoms. In addition, we did not find any statistically significant relationship between cognitive functions and the duration of illness. Conclusion The study provides evidence that institutionalization is not an influential factor on cognitive impairment patients with schizophrenia. However, the psychopathological aspects of the disorder are one of the crucial factors affecting the cognitive function in schizophrenia.

scholarly journals Association of APOE ε4 genotype and lifestyle with cognitive function among Chinese adults aged 80 years and older: A cross-sectional study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (6) ◽  
pp. e1003597
Author(s):  
Xurui Jin ◽  
Wanying He ◽  
Yan Zhang ◽  
Enying Gong ◽  
Zhangming Niu ◽  
...  
Keyword(s):  
Physical Activity ◽  
Body Weight ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Genetic Risk ◽  
Healthy Lifestyle ◽  
Mmse Score ◽  
Oldest Old ◽  
Cross Sectional ◽  
The Mean

Background Apolipoprotein E (APOE) ε4 is the single most important genetic risk factor for cognitive impairment and Alzheimer disease (AD), while lifestyle factors such as smoking, drinking, diet, and physical activity also have impact on cognition. The goal of the study is to investigate whether the association between lifestyle and cognition varies by APOE genotype among the oldest old. Methods and findings We used the cross-sectional data including 6,160 oldest old (aged 80 years old or older) from the genetic substudy of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) which is a national wide cohort study that began in 1998 with follow-up surveys every 2–3 years. Cognitive impairment was defined as a Mini-Mental State Examination (MMSE) score less than 18. Healthy lifestyle profile was classified into 3 groups by a composite measure including smoking, alcohol consumption, dietary pattern, physical activity, and body weight. APOE genotype was categorized as APOE ε4 carriers versus noncarriers. We examined the associations of cognitive impairment with lifestyle profile and APOE genotype using multivariable logistic regressions, controlling for age, sex, education, marital status, residence, disability, and numbers of chronic conditions. The mean age of our study sample was 90.1 (standard deviation [SD], 7.2) years (range 80–113); 57.6% were women, and 17.5% were APOE ε4 carriers. The mean MMSE score was 21.4 (SD: 9.2), and 25.0% had cognitive impairment. Compared with those with an unhealthy lifestyle, participants with intermediate and healthy lifestyle profiles were associated with 28% (95% confidence interval [CI]: 16%–38%, P < 0.001) and 55% (95% CI: 44%–64%, P < 0.001) lower adjusted odds of cognitive impairment. Carrying the APOE ε4 allele was associated with 17% higher odds (95% CI: 1%–31%, P = 0.042) of being cognitively impaired in the adjusted model. The association between lifestyle profiles and cognitive function did not vary significantly by APOE ε4 genotype (noncarriers: 0.47 [0.37–0.60] healthy versus unhealthy; carriers: 0.33 [0.18–0.58], P for interaction = 0.30). The main limitation was the lifestyle measurements were self-reported and were nonspecific. Generalizability of the findings is another limitation because the study sample was from the oldest old in China, with unique characteristics such as low body weight compared to populations in high-income countries. Conclusions In this study, we observed that healthier lifestyle was associated with better cognitive function among the oldest old regardless of APOE genotype. Our findings may inform the cognitive outlook for those oldest old with high genetic risk of cognitive impairment.

scholarly journals Submaximal angioplasty for symptomatic intracranial atherosclerosis: a prospective Phase I study

2016 ◽  
Vol 125 (4) ◽  
pp. 964-971 ◽  
Author(s):  
Travis M. Dumont ◽  
Ashish Sonig ◽  
Maxim Mokin ◽  
Jorge L. Eller ◽  
Grant C. Sorkin ◽  
...  
Keyword(s):  
Phase I ◽  
Medical Management ◽  
Recurrent Stroke ◽  
Smoking History ◽  
Inclusion Criteria ◽  
Intracranial Atherosclerotic Disease ◽  
Stenosis Rate ◽  
Prospective Phase ◽  
The Mean ◽  
Aggressive Medical Management

OBJECTIVE Intracranial atherosclerotic disease (ICAD) accounts for approximately 10% of ischemic strokes. The recent Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study demonstrated a high incidence of perioperative complications (15%) for treatment of ICAD with stenting. Although the incidence of stroke was lower in the medical arm, recurrent stroke was found in 12% of patients despite aggressive medical management, suggesting that intervention may remain a viable option for ICAD if perioperative risk is minimized. Angioplasty without stenting represents an alternative and understudied revascularization treatment for ICAD. Submaximal angioplasty limits the risks of thromboembolism, vessel perforation, and reperfusion hemorrhage that were frequently reported with stenting in the SAMMPRIS trial. The authors conducted a prospective Phase I trial designed to assess the safety of submaximal angioplasty in patients with symptomatic ICAD. METHODS This study was approved by the local institutional review board. Demographic and clinical data were prospectively collected. Angioplasty was performed with a balloon undersized to approximately 50%–70% of the nondiseased vessel diameter in patients with symptomatic ICAD who had angiographically significant stenosis of ≥ 70%. The primary outcome measure was the incidence of periprocedural complications (combined rate of death, stroke, and hemorrhage occurring within 30 days and at 1 year). RESULTS Among the 65 patients with symptomatic ICAD who were screened, 24 had significant angiographic stenosis that met the inclusion criteria of this study. The mean age was 64.08 years (median 65 years; SD ± 11.24 years), most were men (62.5%), and most were white (66.67%). Many patients had concomitants of vascular disease, including hypertension (95.8%), hyperlipidemia (70.83%), smoking history (54.1%), and diabetes mellitus (50.0%). Coronary artery disease (41.66%) and previous stroke or transient ischemic attack (45.83%) were frequently present. Most patients (75%) had anterior circulation stenosis. The mean preprocedure stenosis was 80.16% (median 80%, range 70%–95%). Submaximal angioplasty was performed in patients who met the inclusion criteria, with a mean postangioplasty stenosis rate of 54.62% (median 55.5%, range 31%–78%). Rates of ischemic stroke in the territory of the treated artery were 0% within 30 days and 5.55% (in the only patient who presented with recurrent stroke) at 1 year. The mortality and hemorrhage rates in this series were 0%. CONCLUSIONS This study demonstrates the safety of the submaximal angioplasty technique, with no permanent periprocedural complications in 24 treated patients.

scholarly journals Effect of a Tai Chi-Based Exercise Program on Cognitive Function Among Older Adults With Dementia

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 186-187
Author(s):  
Rhayun Song ◽  
Myonghwa Park ◽  
Misook Jung ◽  
Hyun Li Kim ◽  
Hanna Lee
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Formal Education ◽  
Tai Chi ◽  
Short Term Memory ◽  
Exercise Program ◽  
Early Dementia ◽  
The Mean ◽  
The Relationship

Abstract Cognitive function with dementia is strongly associated with physical function decline. A low intensity aerobic exercise, such as Tai Chi, may help either prevent or slow down cognitive impairment. This study aimed to examine the effect of Tai Chi-based exercise program on cognitive function among older adults with early dementia. Individuals registered at the Dementia Support Center were invited to participate in the Tai Chi-based exercise program twice a week for one-hour session for 20 weeks. The comparison group with the same inclusion criteria but not participated in any formal exercise program were recruited by matching with age, education, and pre-cognitive function. Cognitive function (MOCA-K) was measured at the pretest and at the completion of the study period. Fifty-two older adults with dementia (29 in Tai Chi group, 23 comparisons) with the mean age of 80.5 years completed all measurements. All participants had at least one chronic disease. About 50% of the participants received no formal education. At the completion of the study, Tai Chi group improved their cognitive function, while their counterpart remained similar in their MOCA-K score, specifically in attention (F=5.21, p=.027) and short term memory recall (F=6.66, p=.013). In conclusion, Tai Chi-based exercise program was safely and effectively applied to older adults with early dementia. The participants were able to follow the movements with the attendance rates of 80% during the study period. Further studies are warranted to explore the relationship between physical exercise and cognitive function in this population with various types of cognitive impairment.

Abstract WP124: Signal Intensity Ratio Does Not Predict Recurrent Stroke in Patients with Symptomatic Intracranial Atherosclerotic Disease

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Owaiz Ansari ◽  
Rajbeer S Sangha ◽  
Sameer Ansari ◽  
Shyam Prabhakaran
Keyword(s):  
High Risk ◽  
Signal Intensity ◽  
Intensity Ratio ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Signal Intensity Ratio ◽  
Single Center ◽  
Tof Mra ◽  
Intracranial Atherosclerotic Disease ◽  
Stenotic Lesions

Background: Symptomatic intracranial atherosclerotic disease (ICAD) is associated with high risk for recurrent stroke. Identification of patients remains a challenge using clinical and radiographic markers. Recent research has identified signal intensity ratio (SIR) across stenotic lesions on time-of-flight magnetic resonance angiography (TOF-MRA) as a novel noninvasive marker of recurrent stroke risk. We sought to externally validate this approach in a single center analysis. Methods: From a prospective observational stroke registry since August 2012, we identified patients with ischemic stroke due to ICAD causing moderate-severe stenosis of the basilar, intracranial vertebral, intracranial internal carotid, or middle cerebral arteries. Using the method described previously, we calculated SIR values across the stenotic lesions corrected for background signal intensity from TOF-MRA performed within 7 days of index stroke admission. Outcomes were prospectively captured by phone interview at 1 and 3 months after stroke. Recurrent stroke was defined by new infarct in the territory of the stenotic artery or absent imaging confirmation, territory-specific clinical symptoms lasting > 24 hours. We evaluated whether baseline SIR values were different between patients with and without recurrent stroke overall and in subgroups by ICAD location. P-value < 0.05 was considered significant. Results: Among 99 consecutive patients with ICAD, 79 (80%) had interpretable MRAs at baseline (mean age 68.4 +11.2 years, 53.2% male, 53.2% black, median NIHSS score 3; 27.7% posterior circulation stenosis). Recurrent stroke occurred in 21.5% and 25.3% of patients at 1 and 3 months, respectively. Median SIR at baseline was 0.86 (interquartile range 0.56-1.04) and was not different those with vs. without recurrent stroke (1-month: 0.79 vs. 0.86, p=0.93; 3-month: 0.79 vs. 0.86, p=0.68). Results were not different by ICAD location. Discussion: In this single center prospective registry, we were unable to validate SIR on time-of-flight MRA as a marker of early recurrent stroke risk in patients with symptomatic ICAD. Further research is needed to identify novel predictors of recurrence in this high-risk cohort.

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