Lancet Neurology: Prevalence, predictive factors, and prognosis of symptomatic intracranial stenosis in patients with transient ischemic episodes or mild stroke: a population-based queue study

Stroke, also known as stroke, is an acute cerebrovascular disease that causes brain tissue damage, including ischemic and hemorrhagic stroke, due to a sudden rupture of blood vessels in the brain or a failure of blood vessels to flow into the brain.
incidence of ischemic stroke is higher than hemorrhagic stroke, accounting for 60% to 70% of the total number of strokes.
atherosclerosis stenosis, which affects the brain's aorta, is a common cause of isnemic stroke.
serious cases can cause death.
stroke has the characteristics of high morbidity, high mortality and high disability rate.
symptomatic intracranial stenosis is considered a high risk factor for stroke recurrence, but two previous trials (SAMMPRIS and VISSIT) have not shown that intracranial stenosis is superior to purely intensive medical treatment.
These findings are due in part to a lower-than-expected risk of stroke recurrence in patients who do not have stent infusion, which may reflect the younger age of the recruited patients (median age of 60 years) and raise questions about the popularity of conventional clinical practice.
this paper focuses on the age-specific prevalence, predictive factors, and prognosis of symptomatic intracranial stenosis in patients with population-based acute cerebral ischemic episodes and mild stroke.
(OXVASC) is a forward-looking incidence cohort study of all vascular events in 92,728 people living in Oxfordshire, England.
All patients with transient isoemia episodes and mild isoemia strokes between 1 March 2011 and 1 March 2018 (follow-up until 28 September 2018) are determined by a variety of methods, regardless of age.
imaging examination uses MR angiograms of intracranial and cervical arteries, CT angiograms if MR angioscopy is taboo, and transcranial Doppler and cervical artery ultrasound if CT angiograms are taboo.
In this study, all patients received intensive stent-free therapy and analyzed patients with intracranial vascular imaging to assess the age-specific prevalence of 50-99% intracranial stenosis and the associated stroke risk of 50-99% and 70-99% stenosis during follow-up as of September 28, 2018.
241 (17.6%) of the 1,368 eligible intracranial vascular imaging patients (50-99%) had symptomatic or asymptomatic intracranial stenosis.
prevalence of symptomatic intracranial stenosis increased from 29 (4.9%) out of 596 persons under 70 years of age to 10 (19.6%) out of 51 persons over 90 years of age (ptrend-lt;0.0001).
Of the 94 patients with symptomatic intracranial stenosis rates of 50-99%, 14 (14.9%) had relapsed stroke (12 ischemic strokes and 2 hemorrhagic strokes) during the medium follow-up period of 2-8 years (IQR 1.5-4.6).
Although symptomatic intracranial stenosis increases the risk of ischemic stroke compared to intracranial stenosis (adjusted risk ratio is 1.43, 95% confidence interval is 1.04-1.96), 70-99% of patients with symptomatic intracranial stenosis tend to have a lower risk of ischemic stroke in the same area than in previous trial stents.
In summary, intracranial stenosis was prevalent in elderly Caucasian patients with mild ischemic stroke or transient ischemic episodes, and the risk of recurrence of stroke after symptomatic intracranial stenosis was consistent with two randomized controlled trials (SAMMPRIS and VISSIT) in young people.
Considering that trial results may be generally applicable to a wider patient population, routine screening for intracranial stenosis may not be sufficient to identify candidates for stent implantation, but intracranial stenosis does identify patients at higher risk of atherosclerosis who may need to be tracked or risk factors managed and recruited for future clinical trials.
Hurford, Robert et al. Prevalence, predictors, and prognosis of symptomatic intracranial stenosis in patients with transient ischaemic attack or minor stroke: a population-based cohort study. The Lancet Neurology, Volume 19, Issue 5, 413 - 421 MedSci Original Source: MedSci Original Copyright Notice: All text, images and audio and video materials on this website that indicate "Source: Met Medical" or "Source: MedSci Original" are owned by Mets Medical and are not authorized to be reproduced by any media, website or individual.
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