Patterns Of Index And Recurrent Stroke In Patients With Intracranial Stenosis

Background and Purpose: Pattern of infarct due to ICAS (e.g. borderzone) may predict recurrent stroke risk. We sought to describe the patterns of index and recurrent infarcts in patients enrolled in the medical arm of the SAMMPRIS Trial (Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis). Methods: - Patients enrolled in the medical management arm of the SAMMPRIS trial with infarct as the qualifying event who had CT or MRI, or those with a recurrent infarct in the territory of the symptomatic artery during follow up were included. Infarct pattern for both the index infarct and any recurrent infarct in the territory was determined using criteria defined in prior SAMMPRIS publications as borderzone, MCA artery core, and perforator for anterior circulation and cerebellar, perforator and distal for posterior circulation (see figure for examples). Infarct pattern was adjudicated independently by 2 reviewers, with a 3 rd reviewer as tiebreaker. Results: - Among the 142 patients who had index infarcts in the anterior circulation (n=101) and posterior (n=41) circulation, the patterns were: 53 (37.3%) borderzone, 24 (16.9%) MCA core, 35 (24.6%) perforator, 13 (9.2%) distal, and 17 (12%) cerebellar. Among the 31 who had recurrent infarct in the territory, the patterns were: 10 (32.3%) borderzone, 6 (19.4%) MCA core, 6 (19.4%) perforator, 4 (12.9%) distal, 1 (3.2%) cerebellar, and 4 (12.9%) were missing imaging. Of the recurrent infarcts in territory, 21 had both index infarct and recurrent infarct in territory adjudications, with 11 demonstrating the same pattern of infarct for both events (7 borderzone, 2 core, 2 perforator). Conclusions: - The majority of patients with stroke due to severe symptomatic intracranial stenosis demonstrated borderzone pattern of infarct for index and recurrent infarcts. Ongoing analyses of this dataset will determine the association between pattern of index stroke and risk of recurrent stroke.