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Dong-Wha Kang, MD, PhD; Sun U. Kwon, MD, PhD; Sung-Hee Yoo, RN, MS; Kyum-Yil Kwon, MD; Choong Gon Choi, MD, PhD; Sang Joon Kim, MD, PhD; Jae-Young Koh, MD, PhD; Jong S. Kim, MD, PhD

Arch Neurol. 2007;64(1):50-54.

Background  Prior observations have shown that early recurrent ischemic lesions (ERILs) on diffusion-weighted imaging occur frequently within the first week after an index stroke.

Objective  To investigate differential patterns of ERILs among stroke subtypes, particularly intracranial large-artery atherosclerosis (IC-LAA).

Design  Retrospective study.

Setting  Tertiary university hospital.

Patients  We included 133 patients who experienced an acute ischemic stroke and who underwent initial diffusion-weighted imaging within 24 hours and subsequent diffusion-weighted imaging within 7 days after onset, and whose stroke subtype was IC-LAA, extracranial LAA (EC-LAA), or cardioembolism (CE).

Main Outcome Measure  Early recurrent ischemic lesions were defined as new ischemic lesions on follow-up diffusion-weighted imaging, separate from the index stroke lesion.

Results  Early recurrent ischemic lesions were observed in the following proportions: 50.9% (28/55) in the IC-LAA group, 47.4% (9/19) in the EC-LAA group, and 44.1% (26/59) in the CE group. Early recurrent ischemic lesions in the IC-LAA group had the following characteristics: (1) they occurred mostly (27 [96.4%] of 28) in the pial area of the same vascular territory as the index stroke; (2) they were more frequently observed in a higher grade of stenosis than in milder stenosis (P<.001), whereas ERILs in the EC-LAA group were not related to the degree of stenosis; (3) they were not associated with subsequent recanalization, whereas ERILs in the CE group were mostly associated with subsequent recanalization (P<.001); and (4) they were more closely associated with clinical recurrence than in the EC-LAA or CE group (P=.02).

Conclusion  Early recurrent ischemic lesions in the IC-LAA group are relatively frequent and have different patterns than in the EC-LAA or CE group.

Author Affiliations: Departments of Neurology (Drs Kang, S. U. Kwon, K.-Y. Kwon, Koh, and J. S. Kim and Ms Yoo) and Radiology (Drs Choi and S. J. Kim), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.