Abstract 121: Symptomatic Intracranial Atherosclerotic Disease in Acute Cerebral Ischemia: Frequency, Clinical Course and Short-Term Outcome in a Tertiary Care Hospital in the Southeastern United States

Abstract

Background: In the recently stopped SAMMPRIS trial, enrolled patients had to be stable for at least 3 days since the index event. Following that, the early results suggest a benefit with aggressive medical therapy and risk factor modification. We sought to explore the frequency, risk of early neuroworsening (NW), stroke recurrence and short-term prognosis in patients with symptomatic intracranial atherosclerotic disease (IAD). Methods: We retrospectively reviewed our consecutive stroke database for patients with acute cerebral ischemia admitted in 2010 to our tertiary hospital. Demographics, vascular risk factors, clinical and imaging data were collected. The extent of IAD (mild <50%, moderate 50-69%, severe 70-99%) was identified by MRA, CTA and DSA. Early stroke-related NW was defined as in-hospital increase in the NIHSS score (>2 points) without any systemic cause. Functional outcome (mRS), stroke recurrence rate and death were also determined at discharge and follow-up. Results: A total of 438 patients with acute cerebral ischemia were reviewed (18% TIA; median age 65, range 21-99; 51% men, 61% Caucasians; median NIHSS 5, range 0-40), of which 408 (93%) had vascular imaging. IAD was present in 98/408 (24%) patients with 40 (9.8%) symptomatic 50-99% IAD. Baseline characteristics, clinical data and outcomes are summarized in the Table . The median follow-up time was 31 (0-507) days. After adjusting for known confounders, neither moderate nor severe IAD alone predicted early NW, functional outcome, stroke recurrence or death (at discharge or follow-up). However, when the 15 cases of 50-69% were combined with the 25 cases of 70-99% IAD (50-99%), symptomatic IAD was a significant independent predictor of early NW (OR 4.2, 95%CI 1.2-14.8, p=0.025), but not of stroke recurrence, outcome or death (at discharge or follow-up). In addition, NW had a strong positive correlation to poor modified Rankin and death (at discharge and follow-up, p<0.001). Conclusions: Symptomatic 50-99% IAD is common in our patient population and it predicts early neuroworsening. The strong correlation between neuroworsening and poor functional outcome and death underscores the importance of prompt diagnostic work-up for IAD. Despite the initial results of SAMMPRIS it is unclear if stenting has no role in acute and subacute management of these patients. This could be a subject of a randomized controlled trial.