Abstract 123: Predictors Of Unfavourable Outcome In Medically Treated Symptomatic Intracranial Atherosclerotic Disease.
Background: Patients with symptomatic intracranial atherosclerotic disease (sICAD) have a 12-14 % annual risk of stroke. The aim of the study was to evaluate the natural history and outcome of patients with sICAD treated medically.
Methods: The study population consisted of first ever TIA or stroke patients presenting to this quaternary care centre during the period of January 2008 to March 2011, who on vascular imaging have isolated intracranial atherosclerosis as cause of their symptoms in whom other potential causes have been ruled out and have a follow up of minimum 90days after onset of index event. Unfavourable outcome was defined as presence of TIA, stroke, acute coronary event or vascular death and modified Rankin scale ≥ 3.
Results: Fifty three (11.8 %) of the 449 first ever ischemic stroke patients had sICAD. The risk of stroke or TIA in the sICAD territory was 20%, 26.7%, 28.9%, 31.1% in first 7days, 30 days, 90days and 1year respectively. Five (11.1%) patients had cardiovascular events, of these more than two-thirds of these events occurred after 90days of index event and were responsible for 50% mortality in the study. The predictors of unfavourable outcome were presentation as limb weakness (85.7% vs. 58.8%, hazard ratio 1.5; 95%CI, 0.05-0.9; p=0.04), NIHSS at admission ≥8 (50% vs. 5.9%, hazard ratio 8.5; 95%CI, 0.007-0.5; p=0.02), MRI with multiple DWI lesions ( 65.4% vs. 26.7% ;95%CI, 0.04-0.7; p=0.01) and angiography suggestive of diffuse atherosclerosis ( 50% vs. 11.8% ; 95%CI, OR 0.02-0.7 ; p=0.009). On stepwise multiple regression independent variables for unfavourable outcome were NIHSS at admission≥8 (p=0.001, t=3.5), multiple DWI lesion on MRI (p=0.04, t=2.9) and diffuse atherosclerosis on angiography (p=0.006, t=2.9).
Conclusion: The patients with sICAD have a very high risk of stroke or TIA in the first 30days even on aggressive medical treatment. Cardiac events are an important cause of mortality and needs close follow-up.
- © 2012 by American Heart Association, Inc.