Article Text
Abstract
Background and purpose Transient ischaemic attack (TIA), transient symptoms with infarction (TSI) and diffusion-weighted imaging (DWI)-negative acute ischaemic stroke (AIS) share similar aetiologies but are considered to have a rather benign prognosis. We intended to investigate the association between intracranial atherosclerotic stenosis (ICAS), extracranial atherosclerotic stenosis (ECAS) and the prognosis of patients with TIA, TSI and DWI-negative AIS.
Methods Clinical and imaging data of eligible participants were derived from the Chinese Intracranial Atherosclerosis study, according to symptom duration, acute infarction on DWI and discharge diagnosis. Based on the severity and location of arterial atherosclerosis, we categorised the study population into four groups: no or <50% ICAS and no ECAS; ≥50% ICAS but no ECAS; no or <50% ICAS with ECAS; and concurrent ≥50% ICAS and ECAS. Using multivariable Cox regression models, we analysed the relationship between the severity and distribution of large artery atherosclerosis and the prognosis of TIA, TSI and DWI-negative AIS.
Results A total of 806 patients were included, 67.3% of whom were male. The median age of the study participants was 63 years. Patients in the concurrent ≥50% ICAS and ECAS subgroup had both a significantly higher 1-year recurrence rate (adjusted HR 3.4 (95% CI 1.15 to 10.04), p=0.027) and a higher risk of composite vascular events (adjusted HR 3.82 (95% CI 1.50 to 9.72), p=0.005).
Conclusions Concurrent ICAS and ECAS is associated with a higher possibility of 1-year recurrent stroke or composite vascular events. Large artery evaluation is necessary to assess patients with transient ischaemic symptoms or DWI-negative AIS. Progress in shortening the time interval between symptom onset and large vessel evaluation is needed.
- stroke
- atherosclerosis
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Contributors YJW had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. YJW designed the study. YS, JJ and YSP collected the data. YS wrote the manuscript. WC, HZ, HL, YHP, LL, XZ, YLW and XM reviewed, edited and approved the final version.
Funding This study is supported by grants from the National Natural Science Foundation of China (81971091 and 81901177), Beijing Hospitals Authority Youth Programme (QML20190501), Ministry of Science and Technology of the People’s Republic of China (2016YFC0901002, 2016YFC0901001, 2017YFC1310901, 2017YFC1310902, 2017YFC1307905, 2018YFC1311700 and 2018YFC1311706), Beijing Municipal Administration of Hospitals (SML20150502), Beijing Municipal Science & Technology Commission (D171100003017002 and D151100002015003), National Science and Technology Major Project (2017ZX09304018), and Beijing Tiantan Hospital (2018-YQN-1).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The ethics committee of Beijing Tiantan Hospital (IRB approval number: (2007) Hospital Ethical Approval No. 27) gave ethical approval for the study protocol.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. Please contact China National Clinical Research Center for Neurological Diseases.