Stroke recurrence patterns are predicted by the subtypes and mechanisms of the past, non-cardiogenic stroke
Article first published online: 9 FEB 2013
© 2013 The Author(s) European Journal of Neurology © 2013 EFNS
European Journal of Neurology
Volume 20, Issue 6, pages 928–934, June 2013
How to Cite
Yoon, Y., Lee, D. H., Kang, D. W., Kwon, S. U., Suh, D. C., Bang, O. Y. and Kim, J. S. (2013), Stroke recurrence patterns are predicted by the subtypes and mechanisms of the past, non-cardiogenic stroke. European Journal of Neurology, 20: 928–934. doi: 10.1111/ene.12101
- Issue published online: 12 MAY 2013
- Article first published online: 9 FEB 2013
- Manuscript Accepted: 12 DEC 2012
- Manuscript Received: 28 JUL 2012
- Brain Research Center
- Ministry of Science and Technology of Korea. Grant Number: M103KV010010 06K2201 01010
- stroke subtype
Background and purpose
The association between past stroke subtypes and recurrent stroke subtypes in non-cardiogenic stroke remains unknown.
Patients with ischaemic stroke who had a past history of large-artery disease (LAD) or small-artery disease (SAD) subtypes were assessed. LAD was subdivided into intracranial atherosclerosis (ICAS) and extracranial atherosclerosis (ECAS). LAD stroke mechanisms were categorized as artery-to-artery embolism, in situ thrombotic occlusion and local branch occlusion, while SAD was subdivided into lacunar infarction (LI) and branch atheromatous disease (BAD) on the basis of magnetic resonance imaging findings. The relationship between past and current strokes was analyzed.
Among the 202 patients enrolled, the LAD group (n = 111) had 64 and 47 patients with ICAS and ECAS, and the SAD group (n = 91) had 63 and 28 patients with LI and BAD, respectively, at the time of past stroke. Patients with LAD developed LAD-associated strokes most often (n = 99, 89.2%), and patients with SAD developed SAD most often (n = 69, 75.8%; P < 0.001). Patients with ICAS were more likely to develop ICAS later (n = 46, 79.3%), whereas those with ECAS developed ECAS more often (n = 31, 75.6%; P < 0.001). Patients with ICAS presenting with artery-to-artery embolism more often developed artery-to-artery embolism later (n = 26, 72.2%), whereas those with local branch occlusion developed recurrent local branch occlusion most often (n = 10, 66.7%, P = 0.005). In the SAD group, patients with BAD developed LAD more frequently than the LI group (n = 11, 39.3% vs. n = 9, 14.3%, P = 0.022).
The subtypes and mechanisms of recurrent stroke are significantly influenced by those of the past stroke.