Published online before print January 23, 2006, doi: 10.1161/CIRCULATIONAHA.105.578229
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(Circulation. 2006;113:555-563.)
© 2006 American Heart Association, Inc.
Stroke |
Predictors of Ischemic Stroke in the Territory of a Symptomatic Intracranial Arterial Stenosis
From the Department of Neurology, University of Pennsylvania Medical Center (S.E.K.), Philadelphia; Department of Neurology (M.I.C., H.H.-S., B.J.S., M.R.F.) and Department of Biostatistics (M.J.L., V.S.H.), Rollins School of Public Health, Emory University School of Medicine, Atlanta, Ga; Department of Neurology, University of Maryland (B.J.S.), Baltimore; Department of Neurology, Mount Sinai School of Medicine (S.R.L.), New York, NY; Department of Neurology, Wayne State University (S.C.), Detroit, Mich; Department of Neurology, University of Rochester School of Medicine (C.G.B.), Rochester, NY; Department of Neurology, Cleveland Clinic Foundation (C.A.S.), Cleveland, Ohio; Department of Neurology, University of Pittsburgh School of Medicine (T.G.J.), Pittsburgh, Pa; Department of Neurology, University of Miami Medical School (J.G.R.), Miami, Fla; and Department of Radiology, Mayo Clinic (H.J.C.), Rochester, Minn.
Correspondence to Scott E. Kasner, MD, Department of Neurology, University of Pennsylvania, 3 W Gates Bldg, 3400 Spruce St, Philadelphia, PA 19104. E-mail kasner{at}mail.med.upenn.edu
Received July 25, 2005; revision received November 21, 2005; accepted November 23, 2005.
Background— Antithrombotic therapy for intracranial arterial stenosis was recently evaluated in the Warfarin versus Aspirin for Symptomatic Intracranial Disease (WASID) trial. A prespecified aim of WASID was to identify patients at highest risk for stroke in the territory of the stenotic artery who would be the target group for a subsequent trial comparing intracranial stenting with medical therapy.
Methods and Results— WASID was a randomized, double-blinded, multicenter trial involving 569 patients with transient ischemic attack or ischemic stroke due to 50% to 99% stenosis of a major intracranial artery. Median time from qualifying event to randomization was 17 days, and mean follow-up was 1.8 years. Multivariable Cox proportional hazards models were used to identify factors associated with subsequent ischemic stroke in the territory of the stenotic artery. Subsequent ischemic stroke occurred in 106 patients (19.0%); 77 (73%) of these strokes were in the territory of the stenotic artery. Risk of stroke in the territory of the stenotic artery was highest with severe stenosis 
70% (hazard ratio 2.03; 95% confidence interval 1.29 to 3.22; P=0.0025) and in patients enrolled early (
17 days) after the qualifying event (hazard ratio 1.69; 95% confidence interval 1.06 to 2.72; P=0.028). Women were also at increased risk, although this was of borderline significance (hazard ratio 1.59; 95% confidence interval 1.00 to 2.55; P=0.051). Location of stenosis, type of qualifying event, and prior use of antithrombotic medications were not associated with increased risk.
Conclusions— Among patients with symptomatic intracranial stenosis, the risk of subsequent stroke in the territory of the stenotic artery is greatest with stenosis 70%, after recent symptoms, and in women.
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