Evidence map›Paper›PMID 41543997›Full record

ArticleCerebrovascular diseases extra2026

Imaging Markers Predict the Short-Term and Long-Term Stroke Recurrence in Symptomatic Intracranial Atherosclerotic Disease.

Rinta Paul, Anagha Rajiv, Adarsh Anil Kumar, Harini Pavuluri, Soumya Krishnamoorthy, Chandrasekharan Kesavadas, P Sankara Sarma, Shyam Prabhakaran, P N Sylaja

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Article in Cerebrovascular diseases extra, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

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9 authors.

Rinta PaulDepartment of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.
Anagha RajivDepartment of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.
Adarsh Anil KumarDepartment of Imaging Sciences and Intervention Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.
Harini PavuluriDepartment of Neurology, Aster Ramesh Hospital, Vijayawada, India.
Soumya KrishnamoorthyDepartment of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.
Chandrasekharan KesavadasDepartment of Imaging Sciences and Intervention Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.
P Sankara SarmaDepartment of Public Health, Amrita Institute of Medical Sciences and Research Centre, Cochin, India.
Shyam PrabhakaranDepartment of Neurology, The University of Chicago Medical Center, Chicago, Illinois, USA.
P N SylajaDepartment of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India, sylajapn@sctimst.ac.in; sylajapn@hotmail.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionSymptomatic intracranial atherosclerotic disease (ICAD) is associated with a high risk of stroke recurrence despite aggressive medical management. However, recurrence rates and risk factors are less studied in non-Western settings. The study evaluated the clinical and imaging predictors of early and late stroke recurrence in patients with symptomatic ICAD in India.

methodsThis ambispective cohort study enrolled patients with symptomatic ICAD within 1 month of symptom onset from a tertiary stroke care hospital. The intracranial arterial stenosis grade and length, infarct patterns, white matter hyperintensity (WMH), and collateral flow were documented. The primary outcome was recurrent stroke or transient ischemic attack (TIA) within 3 months and 1 year.

resultsOf 876 patients with large artery atherosclerosis, 229 patients were included (mean age 59.7 ± 10.2 years; men, 72.9%). At the end of 1-year follow-up, recurrent ischemic stroke or TIA occurred in 55 (24%) patients. Of these, 47 (20.5%) patients had stroke recurrence within 3 months (early), and 14 (6.1%) patients had stroke recurrence after 3 months to 1 year (late). Six patients had both early and late stroke recurrence. A territorial and cortical infarct pattern (p = 0.038), moderate to severe WMH (p = 0.050), hypertension (p = 0.040), diabetes (p = 0.043), and coronary artery disease (p = 0.034) predicted early stroke recurrence. A territorial and cortical infarct pattern (p = 0.026), greater length of stenosis (p = 0.045), diabetes (p = 0.026), and coronary artery disease (p = 0.044) predicted late recurrence. On multivariate analysis, a territorial and cortical infarct pattern (adj. OR: 2.15; 95% CI: 1.09-4.26; p = 0.028) independently predicted early stroke recurrence.

conclusionA territorial and cortical infarct pattern is an independent predictor of early stroke recurrence, suggesting the role of artery-to-artery embolism and plaque instability as a potential mechanism of early stroke recurrence in patients with symptomatic ICAD.

Indexed as

Cerebral AngiographyIntracranial ArteriosclerosisIschemic Attack, TransientIschemic StrokeMagnetic Resonance AngiographyStrokeAgedCerebrovascular CirculationCollateral CirculationFemaleHumansIndiaMaleMiddle AgedPredictive Value of TestsPrognosisImaging markersInfarct patternIntracranial atherosclerosisPrognosisStroke recurrence

Identifiers

PMID41543997
PMCPMC12948387

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