ArticleBMJ neurology open2026
Same-territory chronic infarcts are common in intracranial atherosclerosis and are associated with future recurrence.
Article in BMJ neurology open, 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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Abstract
Background: Intracranial atherosclerotic disease (ICAD) has a high risk of symptomatic recurrence. We investigated the prevalence of same-territory chronic infarcts among symptomatic ICAD patients, and their ability to discriminate between absence and presence of future same-territory ischaemic events. Methods: In a retrospective analysis of prospectively collected data from two Australian stroke centres, patients were followed for recurrent ischaemia over 12 months. Ability to discriminate between absence and presence of recurrent stroke/TIA (Area-under-curve (AUC) in receiver-operating-characteristic analysis) and degree of model fit (Bayesian information criterion (BIC)) were compared for prognostic characteristics of chronic same-territory stroke, >70% stenosis and CT-perfusion hypoperfusion. Results: From 2019 to 2020, 135 patients had symptomatic ICAD, mean age 73.8 (SD±13.2) and 57/135 (42%) female, of whom 29/135 (21%) had chronic same-territory infarcts. Over a 12-month follow-up period, recurrent cerebrovascular events occurred in 9/29 (31%) patients with, and in 11/106 (10%) without, chronic same-territory stroke (OR 3.9 95% CI 1.4 to 10.6, p=0.008). In discrimination and model fit analysis, BIC indicated strong evidence for improved model fit, for same-territory chronic infarction (AUC 0.64) vs >70% stenosis (AUC 0.58, p=0.59; BIC difference 4.7). In n=99 with CT-perfusion, chronic infarct showed better fit than CT-perfusion hypoperfusion (0.64 vs 0.61, p=0.79; BIC difference 2.8). Chronic infarct alone also outperformed all combinations of chronic infarct, hypoperfusion and >70% stenosis in model fit. Conclusions: Chronic same-territory infarcts are common among patients presenting with symptomatic ICAD and can better discriminate future same-territory ischaemic cerebrovascular events over a 12-month period than stenosis>70% and hypoperfusion on CTP.
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