Supplementary Material for: Imaging Markers Predict the Short-term and Long-term Stroke Recurrence in Symptomatic Intracranial Atherosclerotic Disease

Introduction: Symptomatic intracranial atherosclerotic disease (ICAD) is associated with a high risk of stroke recurrence despite aggressive medical management. However, recurrence rates and risk factors are less studied in non-Western settings. The study evaluated the clinical and imaging predictors of early and late stroke recurrence in patients with symptomatic ICAD in India.
Methods: This ambispective cohort study enrolled patients with symptomatic ICAD within one month of symptom onset from a tertiary stroke care hospital. The intracranial arterial stenosis grade and length, infarct patterns, white matter hyperintensity (WMH), and collateral flow were documented. The primary outcome was recurrent stroke or transient ischemic attack (TIA) within 3 months and 1 year.
Results: Results: Of 876 patients with large artery atherosclerosis, 229 patients were included (mean age 59.7±10.2 years; men, 72.9%). At the end of one-year follow-up, recurrent ischemic stroke or TIA occurred in 55 (24%) patients. Of these, 47 (20.5%) patients had stroke recurrence within 3 months (early), and 14 (6.1%) patients had stroke recurrence after 3 months to one year (late). Six patients had both early and late stroke recurrence. A territorial and cortical infarct pattern (p=0.038), moderate to severe WMH (p=0.050), hypertension (p=0.040), diabetes (p=0.043), and coronary artery disease (p=0.034) predicted early stroke recurrence. A territorial and cortical infarct pattern (p=0.026), greater length of stenosis (p=0.045), diabetes (p=0.026), and coronary artery disease (p=0.044) predicted late recurrence. On multivariate analysis, a territorial and cortical infarct pattern (adj. OR, 2.15; 95% CI, 1.09-4.26; p= 0.028) independently predicted early stroke recurrence.
Conclusion: A territorial and cortical infarct pattern is an independent predictor of early stroke recurrence, suggesting the role of artery-to-artery embolism and plaque instability as a potential mechanism of early stroke recurrence in patients with symptomatic ICAD.

研究背景：症状性颅内动脉粥样硬化性疾病（intracranial atherosclerotic disease, ICAD）即便接受强化药物治疗，仍存在较高的卒中复发风险。然而在非西方人群中，针对该病的复发率及危险因素的研究仍相对匮乏。本研究针对印度的症状性颅内动脉粥样硬化性疾病患者，评估了其早期及晚期卒中复发的临床与影像学预测因素。

研究方法：本研究为双向队列研究，纳入某三级卒中中心发病1个月内的症状性颅内动脉粥样硬化性疾病患者。研究人员记录了患者的颅内动脉狭窄程度与狭窄长度、梗死类型、脑白质高信号（white matter hyperintensity, WMH）以及侧支循环情况。本研究的主要结局指标为随访3个月及1年内的复发性卒中或短暂性脑缺血发作（transient ischemic attack, TIA）。

研究结果：共纳入876例大动脉粥样硬化患者中的229例，患者平均年龄为59.7±10.2岁，男性占比72.9%。随访1年结束时，共有55例（24%）患者出现复发性缺血性卒中或短暂性脑缺血发作；其中47例（20.5%）在3个月内发生早期复发，14例（6.1%）在3个月至1年期间发生晚期复发，另有6例患者同时出现早期与晚期复发。
单因素分析显示，皮层-区域型梗死模式（p=0.038）、中重度脑白质高信号（p=0.050）、高血压（p=0.040）、糖尿病（p=0.043）以及冠状动脉疾病（p=0.034）为早期卒中复发的预测因素；而皮层-区域型梗死模式（p=0.026）、更长的狭窄长度（p=0.045）、糖尿病（p=0.026）以及冠状动脉疾病（p=0.044）为晚期卒中复发的预测因素。
多因素回归分析显示，皮层-区域型梗死模式（校正比值比=2.15，95%置信区间：1.09~4.26，p=0.028）是早期卒中复发的独立预测因素。

研究结论：皮层-区域型梗死模式是早期卒中复发的独立预测因素，这提示动脉-动脉栓塞及斑块不稳定可能是症状性颅内动脉粥样硬化性疾病患者早期卒中复发的潜在病理机制。