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(Stroke. 2009;40:1999.)
© 2009 American Heart Association, Inc.

Original Contributions

Causes and Severity of Ischemic Stroke in Patients With Symptomatic Intracranial Arterial Stenosis

Bolanle M. Famakin, MD; Marc I. Chimowitz, MBChB; Michael J. Lynn, MS; Barney J. Stern, MD; Mary G. George, MD for the WASID Trial Investigators

From the Department of Neurology (B.M.F., M.I.C., B.J.S.), Emory University School of Medicine, and the Department of Biostatistics (M.J.L., M.G.G.), The Rollins School of Public Health of Emory University, Atlanta, Ga.

Correspondence to Dr Bolanle M. Famakin, National Institutes of Health, National Institute of Neurological Disorders and Stroke, Stroke Branch, 49 Convent Drive, Building 49, Room 2A51, MSC 4476, Bethesda, MD 20892. E-mail famakinb{at}ninds.nih.gov

Background and Purpose— There are limited data on the causes and severity of subsequent stroke in patients presenting initially with TIA or stroke attributed to intracranial arterial stenosis.

Methods— We evaluated the location, type (lacunar vs nonlacunar), cause, and severity of stroke in patients who had an ischemic stroke endpoint in the Warfarin Aspirin Symptomatic Intracranial Disease (WASID) trial.

Results— Of the 569 patients enrolled in the WASID trial, 106 patients (18.6%) had an ischemic stroke during a mean follow-up of 1.8 years. Stroke occurred in the territory of the symptomatic artery in 77 (73%) of 106 patients. Among the 77 strokes in the territory, 70 (91%) were nonlacunar and 34 (44%) were disabling. Stroke out of the territory of the symptomatic artery occurred in 29 (27%) of 106 patients. Among these 29 strokes, 24 (83%) were nonlacunar, 14 (48%) were attributed to previously asymptomatic intracranial stenosis, and 9 (31%) were disabling.

Conclusions— Most subsequent strokes in patients with symptomatic intracranial artery stenosis are in the same territory and nonlacunar, and nearly half of the strokes in the territory are disabling. The most commonly identified cause of stroke out of the territory was a previously asymptomatic intracranial stenosis. Penetrating artery disease was responsible for a low number of strokes.

Key Words: acute stroke • intracranial stenosis • lacunar infarcts • severity • WASID