Impaired Perfusion and Early Ischemic Stroke Recurrence in Symptomatic Intracranial Atherosclerosis: BIORISK ICAS Study.
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Yaghi Shadi, Khan Farhan, Lewis Skylar, Stipanovich Ava, Choi Richard, Baker Richard, Al Kasab Sami, Abu Qdais Ahmad, Yaddanapudi Sridhara S, Sultana Sabiha, Khan Muhib, Malik Maarij, Klaas James, Bakradze Ekaterina, Aemaz Ur Rehman Muhammad, Leon Guerrero Christopher, Ressler Hadley Walsh, Saleh Velez Faddi G, Owens Cameron, Pinto Camila Bonin, McCullough-Hicks Margy, Cooper Dawson, Parameswaran Pillai Abhiram, Hariharan Praveen, Alam Shaista, Mayer Morgan, Heldner Mirjam R, Kugler Irina, Antonenko Kateryna, Almiri William, Martins Sheila, Secchi Thais L, Mantovani Gabriel, Rothstein Aaron, Sloane Kelly, Krishnaiah Balaji, Alfred Linda, Elangovan Cheran, Vishnu Venugopalan Y, Chandu Meena, Agarwal Ayush, Romoli Michele, Marrone Nicola, Vozzi Stefano, Ghannam Malik, Elshikh Mohamed, Dibas Mahmoud, Hou Yan, Peshwe Krithika, Tunguturi Ajay, Marto João Pedro, Duarte Armindo Rui, Frontera Jennifer, Kuohn Lindsey, AlMajali Mohammad, Zaidat Osama O, Barakat Benan, Khan Niha, Simpkins Alexis N, Sen Shayak, Coelho Mariana, Sargento Fritas Joao, Sousa Joao Andre, Aguiar de Sousa Diana, Soares Mafalda, Cyntia Lima Fonseca Rodrigues Amanda, Jhaveri Aditya, Morsi Rami Z, Siegler James, Aziz Yasmin N, Harker Pablo, Bhati Sonia, Vassilopoulou Sophia, Tountopoulou Argyro, de Havenon Adam, Muddasani Varsha, Henninger Nils, Tran Hieu, Helenius Johanna, Khasawneh Mohammad, Vellimana Ananth, Apfel Ryan, Molaie Amir, Mannino Marina, Terruso Valeria, El Halabi Tarek, Reda Mahasen, Tamer Christel, Klein Piers, Shu Liqi, Khatri Pooja, Furie Karen, Nguyen Thanh N, Liebeskind David S, Prabhakaran Shyam
Аннотация
METHODS: The BIORISK ICAS (Biomarkers and Recurrence Risk in Symptomatic Intracranial Atherosclerosis) is a multicenter retrospective international study (35 sites) that included hospitalized patients with symptomatic ICAS (50%-99% luminal stenosis of the intracranial vertebral, basilar, distal internal carotid, or proximal middle cerebral artery) from January 2019 to June 2024. The primary outcome was recurrent ischemic stroke in the territory of the symptomatic artery within 90 days. In the primary analysis, the exposure was an acute anterior circulation borderzone infarct. In secondary analysis of the subset with presentation within 72 hours of last known normal and perfusion imaging completed, the exposure of interest was prespecified as hypoperfusion mismatch volume at Tmax (time to maximum) threshold of 6 seconds, dichotomized at the Youden index. We performed multivariable Cox regression to test associations between exposure variables and the outcome, adjusting for clinically relevant variables and those associated with the outcome (P<0.1).
RESULTS: Of 2050 patients with symptomatic ICAS, 1737 (84.7%) presented within 72 hours of symptom onset, among whom 509 (29.3%) underwent perfusion imaging. The primary analysis included 1891 patients; 174 (9.2%) patients had recurrent ischemic stroke in the symptomatic arterial territory. In adjusted Cox regression models, there was an association between anterior circulation borderzone infarct and recurrent ischemic stroke at 90 days (adjusted hazard ratio, 1.40 [95% CI, 1.02-1.93]). In the perfusion imaging analysis, hypoperfusion mismatch of ≥10 mL was associated with recurrent ischemic stroke (adjusted hazard ratio, 1.83 [95% CI, 1.03-3.28]).
CONCLUSIONS: Biomarkers of impaired distal perfusion, anterior circulation borderzone infarct, and hypoperfusion mismatch were associated with increased risk of recurrent ischemic stroke. These findings support the use of perfusion imaging in ICAS as well as future trials investigating early reperfusion in high-risk patients with ICAS.