Abstract 79: Mechanisms of Early Recurrence in Intracranial Atherosclerotic Disease (MyRIAD) Study: Participants, Clinical and Imaging Outcomes

Abstract

Introduction: ICAD is a common cause of stroke. MyRIAD is designed to identify mechanisms of ischemia and predictors of recurrence in ICAD. Here we present the study population baseline characteristics and key outcomes. Methods: MyRIAD is an NIH/NINDS funded prospective multicenter observational study of patients with recent ( < 21 days) stroke or TIA (recurrent or with DWI) caused by IAD 50-99% without planned angioplasty/stenting. The primary outcome is ischemic stroke in the territory within 1 year of follow up; secondary outcomes are TIA at 1 year and new infarcts on MRI at 6-8 weeks. Qualifying events and clinical and imaging outcomes are centrally adjudicated. Results: MyRIAD enrolled 105 participants. The MyRIAD cohort (Table) had significant atherosclerotic risk factors and received aggressive medical therapy. Of 101 participants with clinical follow up (mean 243 + 126 days), the primary outcome of stroke in the territory at 1 year occurred in 9 (8.6%, 13.4/100 person-years), while 7 (6.7%, 10.4/100 person-years) had a TIA. A study MRI at 6-8 weeks was available for comparison to baseline MRI in 87 participants (mean time from qualifying event to follow up imaging 51 + 16 days). A new DWI/FLAIR infarct in the territory of the symptomatic vessel was noted in 22 participants (25.3%). Conclusions: MyRIAD detected an 8.6% 1-year stroke recurrence and a much higher 25.3% rate of recurrent infarction in the first weeks after qualifying stroke/TIA, emphasizing the need to develop better therapeutic interventions for ICAD.