Hemodynamic Markers in the Anterior Circulation as Predictors of Recurrent Stroke in Patients With Intracranial Stenosis

Ashley M. Wabnitz, From the Department of Neurology, Medical University of South Carolina, Charleston (A.M.W., T.N.T., M.I.C.).
Colin P. Derdeyn, Departments of Radiology, Neurology and Neurosurgery, University of Iowa Hospitals and Clinics (C.P.D.).
David J. Fiorella, Department of Neurosurgery, State University of New York, Stony Brook (D.J.F.).
Michael J. Lynn, Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA (M.J.L., G.A.C.).
George A. Cotsonis, Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA (M.J.L., G.A.C.).
David S. Liebeskind, Department of Neurology, University of California Los Angeles (D.S.L.).
Michael F. Waters, Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (M.F.W.).Follow
Helmi Lutsep, Department of Neurology, Oregon Health and Science University, Portland (H.L.).
Elena López-Cancio, Neurology Department, Stroke Unit, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain (E.L.-C.).
Tanya N. Turan, From the Department of Neurology, Medical University of South Carolina, Charleston (A.M.W., T.N.T., M.I.C.).
Jean Montgomery, Department of Public Health, Emory University, Atlanta, GA (J.M.).
L Scott Janis, Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD (L.S.J.).
Bethany Lane, Piedmont Research Institute, Piedmont Healthcare, Atlanta, GA (B.L.).
Marc I. Chimowitz, From the Department of Neurology, Medical University of South Carolina, Charleston (A.M.W., T.N.T., M.I.C.).

Document Type

Article

Abstract

Background and Purpose- Although aggressive medical therapy was superior to stenting in the SAMMPRIS trial (Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis), the stroke rate in the medical arm was still high. The aim of this study was to determine the association between hemodynamic markers (borderzone infarct pattern and impaired collateral flow on baseline imaging) and rates of recurrent stroke in patients treated medically in SAMMPRIS. Methods- This was a post hoc analysis of patients whose qualifying event for SAMMPRIS was an infarct in the territory of a stenotic middle cerebral artery or intracranial carotid artery. Infarcts were adjudicated as involving primarily internal or cortical borderzone territories, the core middle cerebral artery territory, or perforator territories, and collateral flow was assessed according to a standard scale (American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology). Log-rank tests and χ tests were performed to assess associations of infarct patterns and collateral flow with rates of recurrent stroke. Results- Of 101 patients who qualified, 14 of 53 (26.4%) with borderzone infarcts, 2 of 24 (8.3%) with core middle cerebral artery infarcts, and 3 of 24 (12.5%) with perforator infarcts had a recurrent stroke in the territory ( P=0.14 for comparing the 3 groups, P=0.052 for borderzone versus nonborderzone). Of 82 patients with collateral flow assessment, 30 of 43 (70%) with borderzone infarcts, 7 of 19 (37%) with core middle cerebral artery infarcts, and 11 of 20 (55%) with perforator infarcts had impaired collateral flow distal to the stenosis ( P=0.049). Patients with borderzone infarcts and impaired collateral flow had the highest risk of recurrent stroke (37%). Conclusions- Borderzone infarcts and impaired collateral flow identify a subgroup of patients with intracranial stenosis who are at particularly high risk of recurrent stroke on medical treatment. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT00576693.

Keywords

angioplasty, atherosclerosis, hemodynamic, middle cerebral artery

Publication Date

12-11-2018

Publication Title

Stroke

E-ISSN

1524-4628

First Page

STROKEAHA118020840

PubMed ID

30580705

Digital Object Identifier (DOI)

10.1161/STROKEAHA.118.020840

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