This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (4)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Cerebrovascular Disease  • Stroke  • Alert me on articles by topic  Social Bookmarking   What's this?

A Hospital-Based Follow-up Study

Dong Hoon Shin, MD; Phil Hyu Lee, MD; Oh Young Bang, MD, PhD

Arch Neurol. 2005;62:1232-1237.

Background  Information on the mechanism of recurrent stroke may help physicians treating patients with ischemic stroke. However, the mechanisms of recurrence in each stroke subtype are not well known, especially in Asians.

Objective  To compare the mechanisms of the index and recurrent stroke.

Design  Analysis of data from a prospective acute stroke registry.

Setting  University hospital.

Patients  Using the clinical syndrome, diffusion-weighted imaging, and vascular studies, we divided 901 patients into 5 groups: large-artery atherosclerosis, cardioembolism, small-artery disease, parent-artery disease occluding the deep perforators, and no determined cause. The patients with large-artery atherosclerosis were subdivided into 2 groups: intracranial and extracranial.

Main Outcome Measures  The mechanisms of recurrent vascular events (strokes or coronary heart disease) in subtypes of ischemic stroke were compared.

Results  Ninety-three recurrent vascular events (86 strokes and 7 instances of coronary heart disease) were evaluated. The pattern of recurrent stroke differed for the intracranial and extracranial groups; unlike the patients with intracranial large-artery atherosclerosis, recurrent strokes in the extracranial group were often unpredictable with respect to the site of recurrence and degree of preexisting stenosis. None of the patients in the extracranial group had recurrences that were caused by intracranial large-artery atherosclerosis or vice versa. In patients with small-artery disease and stroke with no determined cause, intracranial stenosis was often found at the time of recurrence.

Conclusions  From prognostic and therapeutic perspectives, patients with atherosclerosis should be divided into those with intracranial large-artery atherosclerosis and extracranial large-artery atherosclerosis. In addition, intracranial large-artery atherosclerosis may be important in the development of small-artery disease and stroke with no determined cause, especially in the population with a higher frequency of intracranial large-artery atherosclerosis.

Author Affiliations: Department of Neurology, School of Medicine, Ajou University, Suwon, South Korea.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Causes and Severity of Ischemic Stroke in Patients With Symptomatic Intracranial Arterial Stenosis
Famakin et al.
Stroke 2009;40:1999-2003.
ABSTRACT | FULL TEXT  

Adiponectin levels in patients with intracranial atherosclerosis
Bang et al.
Neurology 2007;68:1931-1937.
ABSTRACT | FULL TEXT  

Early Recurrent Ischemic Lesions on Diffusion-Weighted Imaging in Symptomatic Intracranial Atherosclerosis
Kang et al.
Arch Neurol 2007;64:50-54.
ABSTRACT | FULL TEXT  

Distribution and outcome of symptomatic stenoses and occlusions in patients with acute cerebral ischemia.
Weimar et al.
Arch Neurol 2006;63:1287-1291.
ABSTRACT | FULL TEXT