Hypoperfusion Distal to Anterior Circulation Intracranial Atherosclerosis is Associated with Recurrent Stroke.

Journal Article (Journal Article)

BACKGROUND AND PURPOSE: In patients with symptomatic vertebrobasilar intracranial atherosclerotic disease (ICAD), impaired distal flow predicts recurrent stroke, but limited data exist on the association between perfusion status and recurrent stroke in anterior circulation ICAD. METHODS: This is a retrospective study of patients hospitalized for symptomatic ICAD with 50-99% stenosis of the intracranial carotid or middle cerebral artery. The primary outcome is recurrent symptomatic ischemic stroke in the territory of the artery with ≥50% stenosis within 90 days. The primary predictor is distal hypoperfusion on magnetic resonance (MR) or computed tomography (CT) perfusion, defined as a ≥15 mL volume of territory of the symptomatic artery with Tmax >6 seconds. RESULTS: Fifty patients met inclusion criteria, including 15 (30%) with recurrent stroke and 15 (30%) with distal hypoperfusion. Distal hypoperfusion was present in 10 of 15 (66.7%) with recurrent stroke versus 5 of 35 (14.3%) without recurrent stroke (P < .001). The hazard ratio for recurrent stroke in patients with distal hypoperfusion was 6.80 (95% confidence interval [CI] 2.31-20.0). CONCLUSION: Distal hypoperfusion in acutely symptomatic ICAD with 50-99% stenosis is associated with stroke recurrence. Distal hypoperfusion could be used to enrich future trials of secondary stroke prevention in ICAD patients.

Full Text

Duke Authors

Cited Authors

  • de Havenon, A; Khatri, P; Prabhakaran, S; Yeatts, SD; Peterson, C; Sacchetti, D; Alexander, M; Cutting, S; Grory, BM; Furie, K; Liebeskind, DS; Yaghi, S

Published Date

  • July 2020

Published In

Volume / Issue

  • 30 / 4

Start / End Page

  • 468 - 470

PubMed ID

  • 32579278

Pubmed Central ID

  • PMC8010594

Electronic International Standard Serial Number (EISSN)

  • 1552-6569

Digital Object Identifier (DOI)

  • 10.1111/jon.12710


  • eng

Conference Location

  • United States