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Original research
Relationship between stroke recurrence, infarct pattern, and vascular distribution in patients with symptomatic intracranial stenosis
  1. Karthikram Raghuram1,
  2. Aditya Durgam1,
  3. Jennifer Kohlnhofer1,
  4. Ayush Singh2
  1. 1 Department of Radiology, University of Texas Medical Branch, Galveston, Texas, USA
  2. 2 Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
  1. Correspondence to Dr Aditya Durgam, Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, USA; adurgam{at}


Objective In view of recent literature suggesting that stroke recurrence and risks related to intervention may be related to plaque physiology/instability, our study sought to discern the pattern of stroke and rates of stoke recurrence as they relate to the anatomy and presentation of the underlying stenosis.

Methods Retrospective chart as well as CT and MR angiographic imaging review of patients in the institutional stroke database was performed, including identification of patient risk factors, medical therapeutic optimization, compliance, serum cholesterol (low density lipoprotein) levels, blood pressure, physical therapy referrals, follow-up clinical status (using the modified Rankin Scales), and rate of recurrent stroke. 39 patients met the inclusion criteria. We evaluated infarct pattern (embolic, adjacent perforator, or watershed) and vascular distribution.

Results Basilar artery stenosis was most likely to present as a perforator stroke and least likely to recur. Patients discharged with suboptimal medical therapy were twice as likely to have a recurrent stroke. Among patients with optimized medical therapy, no recurrent strokes were seen in patients with an embolic infarct pattern, while a 57% recurrence rate was seen in patients with a watershed infarct pattern.

Conclusions Our results suggest that hemodynamic intracranial vascular stenoses may be less responsive to medical therapy, while stenotic lesions caused by plaque destabilization or in perforator territories may benefit from aggressive medical management with delayed or staged endovascular therapy. Recurrence of stroke may be affected both by vascular territory and by aggressive risk factor control, although the latter remains difficult to evaluate.

  • atherosclerosis
  • blood flow
  • embolic
  • stenosis
  • stroke

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  • Contributors Contibutorship statement: JK and AS reviewed the patient electronic medical records, assembled the data sheet, performed the data analysis, and reviewed the manuscript. AD reviewed the patient electronic medical records, performed the data analysis and statistical analysis, drafted and reviewed the manuscript, and submitted the manuscript (as corresponding author). KR oversaw the project, assembled and reviewed the data sheet, performed the data analysis, and drafted and reviewed the manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study was approved by the institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.