The Association among Hyperuricemia, Aspirin Resistance, and Ischemic Events Recurrence in Stroke Patients

Abstract Background: It is unclear about the relationship among hyperuricemia, aspirin resistance (AR) and recurrence of ischemic events in ischemic stroke patients. This study focuses on this topic. Methods: In this prospective, observational, and single-center study, acute ischemic stroke (AIS) patients within 14 days of onset were recruited. Every patient took aspirin 100mg/d during the follow-up period, the aspirin reaction unit (ARU) was detected by the VerifyNow System on the 5-7th day, and serum uric acid (SUA) level was also tested. ARU≥550 is defined as AR. Patients were followed up for 3 years and record ischemic events recurrence in the clinical database we built (including transient ischemic attack, ischemic stroke recurrence, major adverse cardiovascular events, and vascular composite death). Results: A total of 138 patients with newly ischemic stroke were recruited in this study, of which 27 were AR and 14 were hyperuricemia. A total of 119 patients completed 3-year follow up, among which 32 patients experienced at least one endpoint, 23 patients had aspirin resistance, and 12 patients had hyperuricemia. Among these 32 patients, no one had hyperuricemia. In the univariate analysis, hyperuricemia was significantly associated with no ischemic events (p=0.035); the incidence of AR was significantly associated with recurrent ischemic events (p=0.012); hyperuricemia has no association with AR (p=0.457). Conclusions: Hyperuricemia might be a protective factor in patients with AIS, and AR has a significant association with ischemic events recurrence which is not associated with hyperuricemia.

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Frequency of Aspirin Resistance in Ischemic Stroke Patients and Healthy Controls from Colombia

Stroke Research and Treatment ◽

10.1155/2021/9924710 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Alejandro Roman-Gonzalez ◽

Carlos Andrés Naranjo ◽

Walter D. Cardona-Maya ◽

Dionis Vallejo ◽

Francisco Garcia ◽

...

Keyword(s):

Ischemic Stroke ◽

Platelet Aggregation ◽

Univariate Analysis ◽

Aspirin Resistance ◽

Aspirin Therapy ◽

Stroke Recurrence ◽

Healthy Controls ◽

Test Results ◽

Stroke Patients ◽

Ischemic Cerebrovascular Disease

Objective. To evaluate the aspirin resistance prevalence in patients with previous ischemic cerebrovascular disease undergoing aspirin therapy for secondary prevention. Materials and Methods. Three hundred fifty patients presenting ischemic strokes and 100 healthy controls under aspirin treatment were evaluated using the optic platelet aggregation test. Results. Aspirin resistance was found in 7.4% of the patients with ischemic stroke and 4% of controls. Aspirin resistance was associated with stroke recurrence in univariate analysis ( p = 0.004 ). Aspirin resistance was not associated with smoking, diabetes, or hypercholesterolemia. Conclusion. Aspirin resistance is present in Colombian patients with ischemic stroke as well as in healthy controls.

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Study of Outcome of Ischemic Stroke Patient With Atrial Fibrillation

TAJ Journal of Teachers Association ◽

10.3329/taj.v28i2.39072 ◽

2018 ◽

Vol 28 (2) ◽

pp. 1-6

Author(s):

Achinta Kumar Mallick ◽

Md Kafil Uddin ◽

Md Ahmed Ali ◽

Pijus Kumar Kundu ◽

Sheikh Mohammad Emdadul Haque ◽

...

Keyword(s):

Atrial Fibrillation ◽

Risk Factor ◽

Ischemic Stroke ◽

Linear Regression Analysis ◽

Clinical Deterioration ◽

Stroke Recurrence ◽

Stroke Severity ◽

Multivariate Linear Regression Analysis ◽

Stroke Patients

Atrial fibrillation (AF) is a common arrhythmia and a major risk factor for ischemic stroke, especially in the elderly. Patients with nonvalvular AF have a 5-fold excess risk of stroke. However, population-based data are scarce in patients who have experienced a first-ever ischemic stroke in the presence of AF regarding long-term risk of stroke recurrence and case-fatality rate. Aim of the study is to find out the outcome of ischemic stroke patients with Atrial Fibrillation. It was a descriptive type cross sectional study where 125 diagnosed cases of ischemic stroke were included. Presence of atrial fibrillation was detected by electrocardiogram. They were divided into two groups – those with atrial fibrillation and those without. Comparison was done between the two group in term of recurrence, mortality and clinical improvement. Atrial fibrillation was present in 22 (17.6%) of 125 patients with ischemic stroke. Those with AF were more frequently male, aged 45 years and older. The presence of AF was associated with high 3 months (Χ2 =4.562, df = 1, p<0.05) and 6 months mortality (Χ2 =7.868, df = 1, p<0.05), with a higher stroke recurrence rate within the first 6 months follow-up (22.7% versus 7.8% (<0.05)). At 3 months follow up clinical deterioration was noted in 9.1% patient with atrial fibrillation compared to 2.9% patients who had no arrhythmia(p<0.01) and at 6 months follow up clinical deterioration was noted in 18.2% patient with atrial fibrillation compared to 4.9% patients who had no arrhythmia(p<0.01). Ischemic stroke patients with atrial fibrillation had significant mortality within the study period compared to those without atrial fibrillation. Significant deterioration in clinical outcome was noted in atrial fibrillation group after six months. Recurrence was more in ischemic stroke patients with atrial fibrillation. Multivariate linear regression analysis shows atrial fibrillation as well as CKD, Diabetes mellitus and smoking as independent risk factor for recurrence. In conclusion, patients who had an ischemic stroke with accompanying atrial fibrillation had higher mortality, grave stroke severity, more recurrences and poorer functional status than those without atrial fibrillation.TAJ 2015; 28(2): 1-6

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Comparison of Carotid Atherosclerotic Plaque Characteristics between Symptomatic Patients with Transient Ischemic Attack and Stroke using High-Resolution Magnetic Resonance Imaging

10.21203/rs.3.rs-1089154/v1 ◽

2021 ◽

Author(s):

Mingming Lu ◽

Lichen Zhang ◽

Fei Yuan ◽

Peng Peng ◽

Hongtao Zhang ◽

...

Keyword(s):

Ischemic Stroke ◽

Magnetic Resonance ◽

Transient Ischemic Attack ◽

Carotid Arteries ◽

Plaque Burden ◽

Plaque Morphology ◽

Stroke Patients ◽

Carotid Plaques ◽

Ischemic Attack ◽

Ischemic Events

Abstract Background:This study aimed to compare the characteristics of carotid plaques between patients with transient ischemic attack (TIA) and ischemic stroke using magnetic resonance (MR) imaging.Methods：Patients with a recent ischemic stroke or TIA who exhibited atherosclerotic plaques of carotid arteries in the symptomatic sides determined by MR vessel wall imaging were recruited. The plaque morphology and compositions including intraplaque hemorrhage (IPH), lipid-rich necrotic-core (LRNC) and calcification were compared between TIA and stroke patients. Logistic regression was performed to relate the plaque characteristics to the types of ischemic events.Results:A total of 270 patients with TIA or ischemic stroke were recruited. Stroke patients had significantly higher prevalence of diabetes (42.2% vs. 28.2%, p=0.021), greater mean wall area (35.1 ± 10.1 mm2 vs. 32.0 ± 7.7 mm2, p = 0.004), mean wall thickness (1.3 ± 0.2 mm vs. 1.2 ± 0.2 mm, p=0.001), maximum normalized wall index (NWI)(63.9% ± 6.0% vs. 62.2% ± 5.9%, p=0.023) and %volume of LRNC (9.7%± 8.2% vs. 7.4% ±7.9%, p=0.025) in carotid arteries compared to those with TIA. After adjusted for clinical factors, above characteristics of carotid arteries were significantly associated with the type of ischemic events. After further adjusted for maximum NWI, this association remained statistically significant (OR, 1.41; CI, 1.01-1.96; p=0.041).Conclusions:Ischemic stroke patients had larger plaque burden and greater proportion of LRNC in carotid plaques compared to those with TIA. This study suggests that ischemic stroke patients had more vulnerable plaques compared to those with TIA.

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Abstract WP307: Social Factors That influence Follow-up in Stroke Clinic

Stroke ◽

10.1161/str.47.suppl_1.wp307 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Nicholas Osteraas ◽

Sarah Song ◽

Bichun Ouyang ◽

Vivien Lee ◽

Laurel Cherian ◽

...

Keyword(s):

Ischemic Stroke ◽

Marital Status ◽

Acute Ischemic Stroke ◽

Living Arrangement ◽

Academic Medical Center ◽

Univariate Analysis ◽

Stroke Patients ◽

Insurance Type ◽

Race Ethnicity

Background and Objective: Follow-up in outpatient stroke clinic after hospitalization for ischemic stroke is an integral aspect of the management of stroke patients. This study sought to investigate predictors of risk of not following up in outpatient stroke clinic. Methods: We reviewed consecutive acute ischemic stroke patients admitted to an urban academic medical center from 4/2013 to 4/2014. On discharge, all stroke patients except those going to long term acute care received notice of scheduled follow-up stroke clinic appointment date; they also received a phone call 2-3 days prior to the appointment. Univariate analysis examined the relationship between race, ethnicity, marital status, insurance type, and living arrangement with stroke clinic follow up status. Multivariate analysis was performed with logistic regression controlling for significant factors found in our previous study including discharge location, previously documented diagnosis of depression and outpatient physicians at same institution. Results: Among 355 acute ischemic stroke patients, 49% were female and mean age was 65 years. The follow-up rate in stroke clinic was 53%. In univariate analysis, race, ethnicity, marital status, employment status, and insurance type (i.e. self-pay) were not significantly associated with compliance with stroke clinic follow-up. In logistical regression, patients who lived alone were significantly less likely to follow up in stroke clinic compared with those living with family (OR=2.18, 95% CIs=[1.18, 4.03], p=0.01) as were patients who were depressed, (OR=5.99, CIs =[1.47, 24.4], p=0.01) who did not have other doctors at the same institution, (OR=2.23 CIs = [1.31, 3.70] p=0.003] and who were discharged to a facility other than home or acute rehab (OR=4.38, CIs [1.74, 11.03], p=0.003). Conclusions: Institutions taking care of patients with ischemic strokes should be aware that certain patients may be less likely to follow up in clinic and merit additional efforts in order to ensure that they are not lost to follow up.

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Left Atrial Size and Ischemic Events after Ischemic Stroke or Transient Ischemic Attack in Patients with Nonvalvular Atrial Fibrillation

Cerebrovascular Diseases ◽

10.1159/000511393 ◽

2020 ◽

Vol 49 (6) ◽

pp. 619-624

Author(s):

Keisuke Tokunaga ◽

Masatoshi Koga ◽

Sohei Yoshimura ◽

Yasushi Okada ◽

Hiroshi Yamagami ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Transient Ischemic Attack ◽

Left Atrial ◽

Nonvalvular Atrial Fibrillation ◽

Ischemic Event ◽

Increased Risk ◽

Ischemic Attack ◽

Ischemic Events

Background: The present study aimed to clarify the association between left atrial (LA) size and ischemic events after ischemic stroke or transient ischemic attack (TIA) in patients with nonvalvular atrial fibrillation (NVAF). Methods: Acute ischemic stroke or TIA patients with NVAF were enrolled. LA size was classified into normal LA size, mild LA enlargement (LAE), moderate LAE, and severe LAE. The ischemic event was defined as ischemic stroke, TIA, carotid endarterectomy, carotid artery stenting, acute coronary syndrome or percutaneous coronary intervention, systemic embolism, aortic aneurysm rupture or dissection, peripheral artery disease requiring hospitalization, or venous thromboembolism. Results: A total of 1,043 patients (mean age, 78 years; 450 women) including 1,002 ischemic stroke and 41 TIA were analyzed. Of these, 351 patients (34%) had normal LA size, 298 (29%) had mild LAE, 198 (19%) had moderate LAE, and the remaining 196 (19%) had severe LAE. The median follow-up duration was 2.0 years (interquartile range, 0.9–2.1). During follow-up, 117 patients (11%) developed at least one ischemic event. The incidence rate of total ischemic events increased with increasing LA size. Severe LAE was independently associated with increased risk of ischemic events compared with normal LA size (multivariable-adjusted hazard ratio, 1.75; 95% confidence interval, 1.02–3.00). Conclusion: Severe LAE was associated with increased risk of ischemic events after ischemic stroke or TIA in patients with NVAF.

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Outcomes of Ischemic Stroke and Associated Factors Among Elderly Patients With Large-Artery Atherosclerosis: A Hospital-Based Follow-Up Study in China

Frontiers in Neurology ◽

10.3389/fneur.2021.642426 ◽

2021 ◽

Vol 12 ◽

Author(s):

Qianqian Wu ◽

Jingjing Cui ◽

Yuanli Xie ◽

Min Wang ◽

Huifang Zhang ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Protective Factor ◽

Density Lipoprotein ◽

The Elderly ◽

Outcome Data ◽

Stroke Onset ◽

Stroke Recurrence ◽

Large Artery

Large-artery atherosclerotic (LAA) stroke is the most common subtype of ischemic stroke. However, risk factors for long-term outcomes of LAA stroke in the elderly Chinese population have not been well-described. Therefore, we aimed to assess outcomes and risk factors at 3, 12, and 36 months after LAA stroke onset among stroke patients aged 60 years and older. All consecutive LAA patients aged ≥ 60 years were prospectively recruited from Dongying People's Hospital between January 2016 and December 2018. The clinical features and outcome data at 3, 12, and 36 months after stroke were collected. Differences in outcomes and relationship between outcomes and risk factors were assessed. A total of 1,772 patients were included in our study (61.7% male, 38.3% female). The rates of mortality, recurrence, and dependency were 6.6, 12.6, and 12.6%, respectively, at 3 months after stroke onset. The corresponding rate rose rapidly at 36 months (23.2, 78.7, and 79.7%, respectively). We found the positive predictors associated outcomes at 3, 12, and 36 months after stroke onset. The relative risk (RR) with 95% confidential interval (CI) is 1.06 (1.02–1.10, P = 0.006) at 3 months, 1.06 (1.02–1.10, P = 0.003) at12 months, and 1.10 (1.05–1.15, P < 0.001) at 36 months after stroke onset for age; 1.09 (1.01–1.19, P = 0.029) at 12 months for fasting plasma glucose (FPG) level; 4.25 (2.14–8.43, P < 0.001) at 3 months, 4.95 (2.70–9.10, P < 0.001) at 12 months, and 4.82 (2.25–10.32, P < 0.001) at 36 months for moderate stroke; 7.56 (3.42–16.72, P < 0.001) at 3 months, 11.08 (5.26–23.34, P < 0.001) at 12 months, and 14.30 (4.85–42.11, P < 0.001) at 36 months for severe stroke, compared to mild stroke. Hypersensitive C-reactive protein (hs-CRP) level was an independent risk factor for mortality at different follow-up times, with the RR (95%) of 1.02 (1.01–1.02, P < 0.001) at 3 months, 1.01 (1.00–1.02, P = 0.002) at 12 months. White blood cell count (WBC) level was associated with both stroke recurrence (RR = 1.09, 95%CI: 1.01–1.18, P = 0.023) and dependency (RR = 1.10, 95%CI: 1.02–1.19, P = 0.018) at 3 months. In contrast, a higher level of low-density lipoprotein cholesterol (LDL-C) within the normal range was a protective factor for recurrence and dependency at shorter follow-up times, with the RR (95%) of 0.67 (0.51–0.89, P = 0.005) and 0.67 (0.50–0.88, P = 0.005), respectively. These findings suggest that it is necessary to control the risk factors of LAA to reduce the burden of LAA stroke. Especially, this study provides a new challenge to explore the possibility of lowering LDL-C level for improved stroke prognosis.

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Prevalence and Clinical Characteristics of Lacunar Stroke: A Hospital-Based Study

Brain Sciences ◽

10.3390/brainsci11111466 ◽

2021 ◽

Vol 11 (11) ◽

pp. 1466

Author(s):

Mohammed A. Aldriweesh ◽

Waleed A. Alluhidan ◽

Bayan A. Al Bdah ◽

Muath A. Alhasson ◽

Sultan A. Alsaif ◽

...

Keyword(s):

Ischemic Stroke ◽

Health Care Systems ◽

National Institutes Of Health ◽

Stroke Recurrence ◽

Lacunar Stroke ◽

Stroke Patients ◽

Academic Center ◽

Care Systems

Lacunar stroke (LS) is responsible for one-quarter of the overall number of ischemic strokes with long-term complications and carries health and economic issues for patients and health care systems. Therefore, we aimed to investigate lacunar versus non-lacunar strokes in a tertiary academic center. From February 2016 to July 2019, all patients admitted to the stroke unit were retrospectively reviewed. We included LS patients and compared them to other TOAST subtypes. Hemorrhagic stroke and conditions mimicking stroke were excluded. Regression analysis was done to determine LS predictors and outcomes. A 35.5% rate of LS among 989 ischemic stroke patients was found. Most patients (71.9%) were males. Lower National Institutes of Health Stroke Scale (NIHSS) scores at admission and negative history for cardiac diseases were predictors for LS in our population. At discharge, LS patients had low NIHSS scores and shorter hospitalization periods compared to non-LS patients. In conclusion, LS was prevalent among ischemic stroke patients in our cohort. Future studies are highly needed with long follow-up intervals to identify the stroke recurrence, complications, and outcomes.

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The Association between Baseline and 3-Month Albuminuria and 1-Year Prognosis of Ischemic Stroke

Cerebrovascular Diseases ◽

10.1159/000518180 ◽

2021 ◽

pp. 1-8

Author(s):

Dongxue Wang ◽

Yuesong Pan ◽

Hao Li ◽

Hongyi Yan ◽

Xia Meng ◽

...

Keyword(s):

Ischemic Stroke ◽

Functional Outcome ◽

Stroke Recurrence ◽

Stroke Patients ◽

Poor Functional Outcome ◽

Clinical Prognosis ◽

Stroke Outcomes ◽

Stroke Registry ◽

Confounding Variables ◽

Ischemic Attack

Introduction: The association between the changes in albuminuria levels and the clinical prognosis of stroke is unknown. The present study aimed to explore the relationships between changes in albuminuria and the risk of adverse stroke outcomes. Methods: The patients with ischemic stroke or transient ischemic attack from the Third China National Stroke Registry (CNSR-III) who had the urinary albumin-to-creatinine ratio (ACR) detected at baseline and 3-month were recruited. They were classified into 4 groups according to baseline and 3-month ACR and followed up for 1 year. Results: A total of 5,311 patients were finally included in the study. There were 3,738 (70.4%), 483 (9.1%), 451 (8.5%), and 639 (12.0%) patients with no albuminuria, baseline albuminuria, 3-month albuminuria, and persistent albuminuria, respectively. After adjustment for confounding variables, persistent albuminuria was independently associated with all-cause death (hazard ratio [HR], 2.23; 95% CI, 1.17–4.25; p = 0.02), stroke recurrence (HR, 1.55; 95% CI, 1.02–2.36; p = 0.04), and poor functional outcome (OR, 2.22; 95% CI, 1.66–2.96; p < 0.001). Baseline albuminuria was independently associated with poor functional outcome (OR, 1.65; 95% CI, 1.19–2.28; p = 0.003), while 3-month albuminuria was independently associated with stroke recurrence (HR, 1.68; 95% CI, 1.06–2.65; p = 0.03). Conclusions: Changes in albuminuria can predict adverse 1-year outcomes in Chinese ischemic stroke patients. In particular, persistent albuminuria was independently associated with 1-year all-cause death, stroke recurrence, and poor functional outcome.

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Abstract T P291: Impact of Diastolic Dysfunction for Predicting Mortality in Ischemic Stroke and Transient Ischemic Attack Patients

Stroke ◽

10.1161/str.45.suppl_1.tp291 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Yohei Tateishi ◽

Akira Tsujino ◽

Jumpei Hamabe ◽

Osamu Tasaki ◽

Nobutaka Horie ◽

...

Keyword(s):

Ischemic Stroke ◽

Diastolic Dysfunction ◽

Transient Ischemic Attack ◽

Univariate Analysis ◽

Stroke Severity ◽

Lesion Volume ◽

Nihss Score ◽

Ischemic Attack ◽

D Dimer

Background: The aim of this study is to identify whether diastolic dysfunction predicts 90-day mortality and develop and validate a risk score model using information available at hospital presentation in ischemic stroke or transient ischemic attack (TIA) patients Methods: Consecutive ischemic stroke or TIA patients within 48 hours of onset were enrolled. Diastolic filling pressure was estimated as the ratio of early transmitral flow velocity (E) to mitral annular velocity (e’) on transthoracic echocardiography performed within 24 hours of presentation. Plasma brain natriuretic peptide (BNP) and D-dimer were measured on admission. We calculated initial diffusion weighted imaging (DWI) lesion volume. Stroke severity was assessed by the National Institute of Health Stroke Scale (NIHSS) score. Mortality was evaluated at 90-day follow-up. Univariate and multivariate analyses were conducted to identify predictors of 90-day mortality. Results: A total of 265 patients with ischemic stroke or TIA were enrolled. Of these, nineteen (7%) patients deceased at 90-day follow-up. At univariate analysis, higher age (p=0.002), atrial fibrillation (p<0.001), use of antiplatelet agent (p=0.005) and anticoagulant agent (p=0.017), cardioembolic infarction (p<0.001), higher NIHSS score (p<0.001), larger DWI lesion volume (p=0.002), internal carotid artery occlusion (p<0.001), higher E/e’ (p<0.001), PT-INR level (p=0.004), BNP level (p<0.001) and D-dimer level (p<0.001) and lower albumin level (p=0.002) were associated with death. Multivariable predictors of 90-day mortality included higher E/e’ (Odds ratio [OR]=1.176; 95% confidence interval [CI], 1.051 to 1.317), NIHSS score (OR=1.180; 95% CI, 1.067- 1.306) and D-dimer level (OR=1.137; 95% CI, 1.009 to 1.281). The END score (1 point each for E/e’ of >= 18.5, NIHSS score of >= 17 and D-dimer level of >= 2.0) stratified patients with a predicted probability of death rate from 0% to 77.8%. The c statistic was 0.947. Conclusions: Diastolic dysfunction could be one of the most important predictors of 90-day mortality of acute ischemic stroke and TIA. The END score may assist clinicians in estimating stroke mortality at hospital presentation.

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Abstract W P108: The Burden and Topographic Distribution of Intracranial Atherosclerosis Predict Stroke Recurrence: A Longitudinal Study of Acute Ischemic Stroke Patients

Stroke ◽

10.1161/str.45.suppl_1.wp108 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Byung-Su Kim ◽

Gyeong-Moon Kim ◽

Oh Young Bang ◽

Kwang Ho Lee ◽

Chin-Sang Chung

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stroke Recurrence ◽

Intracranial Atherosclerosis ◽

Stroke Patients ◽

Stroke Event ◽

Anterior Circulation ◽

Increased Risk ◽

Ischemic Attack ◽

Topographic Distribution

Introduction: To date, it remains unclear whether the burden and topographic distribution of intracranial atherosclerosis (ICAS) predict subsequent stroke event. Hypothesis: We assessed the hypothesis that the presence of advanced ICAS at the baseline is an independent biomarker to predict future stroke recurrence among acute ischemic stroke patients. Methods: A total of 446 consecutive patients with ischemic stroke or transient ischemic attack (TIA) were included in this study. Cox proportional regression model was used to examine the association between the burden and topographic distribution of ICAS and subsequent ischemic stroke or TIA. Using the MRA findings at the baseline, we classified patients into 3 groups by the number of ICAS: 1) none (n=277); 2) single (n=88); and 3) two or more (n=81), and into 4 groups by the distribution of ICAS: 1) none (n=277); 2) anterior circulation territory (n=89); 3) posterior circulation territory (n=48); and 4) both circulation territories (n=32), respectively. Results and Conclusions: The recurrence rate of ischemic stroke or TIA was 10.8% (n=48) over a median 4.6 years of follow-up. The presence of two or more ICAS (adjusted hazard ratio [HR]: 2.54, 95% CI: 1.31-4.92) and ICAS located in both circulation territories (HR: 3.27, 95% CI: 1.38-7.73) were independently associated with an increased risk of recurrence of ischemic stroke or TIA, after adjustment of vascular risk factors and secondary prevention medication. In conclusion, our findings suggest that advanced ICAS in acute ischemic stroke patients could be an independent predictor for recurrence of ischemic stroke or TIA.

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