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Borderzone Infarcts and Recurrent Cerebrovascular Events in Symptomatic Intracranial Arterial Stenosis: A Systematic Review and Meta-Analysis

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Background and Purpose Intracranial arterial stenosis (ICAS)-related stroke occurs due to three primary mechanisms with distinct infarct patterns: (1) borderzone infarcts (BZI) due to impaired distal perfusion, (2) territorial infarcts due to distal plaque/thrombus embolization, and (3) plaque progression occluding perforators. The objective of the systematic review is to determine whether BZI secondary to ICAS is associated with a higher risk of recurrent stroke or neurological deterioration.Methods As part of this registered systematic review (CRD42021265230), a comprehensive search was performed to identify relevant papers and conference abstracts (with ≥20 patients) reporting initial infarct patterns and recurrence rates in patients with symptomatic ICAS. Subgroup analyses were performed for studies including any BZI versus isolated BZI and those excluding posterior circulation stroke. The study outcome included neurological deterioration or recurrent stroke during follow-up. For all outcome events, corresponding risk ratios (RRs) and 95% confidence intervals (95% CI) were calculated.Results A literature search yielded 4,478 records with 32 selected during the title/abstract triage for full text; 11 met inclusion criteria and 8 studies were included in the analysis (n=1,219 patients; 341 with BZI). The meta-analysis demonstrated that the RR of outcome in the BZI group compared to the no BZI group was 2.10 (95% CI 1.52–2.90). Limiting the analysis to studies including any BZI, the RR was 2.10 (95% CI 1.38–3.18). For isolated BZI, RR was 2.59 (95% CI 1.24–5.41). RR was 2.96 (95% CI 1.71–5.12) for studies only including anterior circulation stroke patients.Conclusion This systematic review and meta-analysis suggests that the presence of BZI secondary to ICAS may be an imaging biomarker that predicts neurological deterioration and/or stroke recurrence.

Abstract

Background and Purpose Intracranial arterial stenosis (ICAS)-related stroke occurs due to three primary mechanisms with distinct infarct patterns: (1) borderzone infarcts (BZI) due to impaired distal perfusion, (2) territorial infarcts due to distal plaque/thrombus embolization, and (3) plaque progression occluding perforators. The objective of the systematic review is to determine whether BZI secondary to ICAS is associated with a higher risk of recurrent stroke or neurological deterioration.Methods As part of this registered systematic review (CRD42021265230), a comprehensive search was performed to identify relevant papers and conference abstracts (with ≥20 patients) reporting initial infarct patterns and recurrence rates in patients with symptomatic ICAS. Subgroup analyses were performed for studies including any BZI versus isolated BZI and those excluding posterior circulation stroke. The study outcome included neurological deterioration or recurrent stroke during follow-up. For all outcome events, corresponding risk ratios (RRs) and 95% confidence intervals (95% CI) were calculated.Results A literature search yielded 4,478 records with 32 selected during the title/abstract triage for full text; 11 met inclusion criteria and 8 studies were included in the analysis (n=1,219 patients; 341 with BZI). The meta-analysis demonstrated that the RR of outcome in the BZI group compared to the no BZI group was 2.10 (95% CI 1.52–2.90). Limiting the analysis to studies including any BZI, the RR was 2.10 (95% CI 1.38–3.18). For isolated BZI, RR was 2.59 (95% CI 1.24–5.41). RR was 2.96 (95% CI 1.71–5.12) for studies only including anterior circulation stroke patients.Conclusion This systematic review and meta-analysis suggests that the presence of BZI secondary to ICAS may be an imaging biomarker that predicts neurological deterioration and/or stroke recurrence.

참고문헌 (40)

  1. Banerjee C, "Stroke caused by atherosclerosis of the major intracranial arteries", Circ Res, 120, pp.502~513 (2017)
  2. Wong LK, "Global burden of intracranial atherosclerosis", Int J Stroke, 1, pp.158~159 (2006)
  3. Sacco RL, "Race-ethnic differences in stroke risk factors among hospitalized patients with cerebral infarction : the Northern Manhattan Stroke Study", Neurology, 45, pp.659~663 (1995)
  4. Tsivgoulis G, "Prevalence of symptomatic intracranial atherosclerosis in Caucasians: a prospective, multicenter, transcranial Doppler study", J Neuroimaging, 24, pp.11~17 (2014)
  5. Yaghi S, "Imaging parameters and recurrent cerebrovascular events in patients with minor stroke or transient ischemic attack", JAMA Neurol, 73, pp.572~578 (2016)
  6. Derdeyn CP, "Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis(SAMMPRIS) : the final results of a randomised trial", Lancet, 383, pp.333~341 (2014)
  7. Chimowitz MI, "Stenting versus aggressive medical therapy for intracranial arterial stenosis", N Engl J Med, 365, pp.993~1003 (2011)
  8. Zaidat OO, "Effect of a balloon-expandable intracranial stent vs medical therapy on risk of stroke in patients with symptomatic intracranial stenosis : the VISSIT randomized clinical trial", JAMA, 313, pp.1240~1248 (2015)
  9. Sangha RS, "Challenges in the medical management of symptomatic intracranial stenosis in an urban setting", Stroke, 48, pp.2158~2163 (2017)
  10. Holmstedt CA, "Atherosclerotic intracranial arterial stenosis: risk factors, diagnosis, and treatment", Lancet Neurol, 12, pp.1106~1114 (2013)
  11. Flusty B, "Intracranial atherosclerosis treatment : past, present, and future", Stroke, 51, pp.e49~e53 (2020)
  12. Yaghi S, "Intracranial atherosclerotic disease", Stroke, 50, pp.1286~1293 (2019)
  13. Narwal P, "Diagnosis and management of active intracranial atherosclerotic disease : a case study", Stroke, 49, pp.e221~e223 (2018)
  14. Dakay K, "Symptomatic intracranial atherosclerosis with impaired distal perfusion : a case study", Stroke, 49, pp.e10~e13 (2018)
  15. de Havenon A, "Hypoperfusion distal to anterior circulation intracranial atherosclerosis is associated with recurrent stroke", J Neuroimaging, 30, pp.468~470 (2020)
  16. Amin-Hanjani S, "Effect of hemodynamics on stroke risk in symptomatic atherosclerotic vertebrobasilar occlusive disease", JAMA Neurol, 73, pp.178~185 (2016)
  17. Prabhakaran S, "Predictors of early infarct recurrence in patients with symptomatic intracranial atherosclerotic disease", Stroke, 52, pp.1961~1966 (2021)
  18. Prabhakaran S, "Abstract wmp45 : Borderzone infarct pattern predicts recurrent stroke in patients with intracranial stenosis", Stroke, 51(Suppl 1), pp.AWMP45~ (2020)
  19. Yaghi S, "Infarct pattern, perfusion mismatch thresholds, and recurrent cerebrovascular events in symptomatic intracranial stenosis", J Neuroimaging, 29, pp.640~644 (2019)
  20. Momjian-Mayor I, "The pathophysiology of watershed infarction in internal carotid artery disease : review of cerebral perfusion studies", Stroke, 36, pp.567~577 (2005)
  21. Yamauchi H, "Hemodynamic compromise as a cause of internal border-zone infarction and cortical neuronal damage in atherosclerotic middle cerebral artery disease", Stroke, 40, pp.3730~3735 (2009)
  22. Kim SJ, "Intracranial atherosclerotic disease mechanistic subtypes drive hypoperfusion patterns", J Neuroimaging, 31, pp.686~690 (2021)
  23. Liu D, "Early magnetic resonance imaging predicts early neurological deterioration in acute middle cerebral artery minor stroke", J Stroke Cerebrovasc Dis, 25, pp.469~474 (2016)
  24. Kim JT, "MRI findings may predict early neurologic deterioration in acute minor stroke or transient ischemic attack due to intracranial atherosclerosis", Eur Neurol, 64, pp.95~100 (2010)
  25. Tamura A, "The relationship between neurological worsening and lesion patterns in patients with acute middle cerebral artery stenosis", Cerebrovasc Dis, 35, pp.268~275 (2013)
  26. Ma Y, "Predictors of neurological deterioration during hospitalization : results from the Chinese intracranial atherosclerosis(CICAS)study", Neurol Res, 37, pp.385~390 (2015)
  27. Easton JD, "Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association", American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention;Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists, 2009, pp.40, 2276~2293
  28. Wallace BC, "Deploying an interactive machine learning system in an evidencebased practice center : abstrackr", Proceedings of the 2nd ACM SIGHIT International Health Informatics Symposium, pp.819~824 (2012), Association for Computing Machinery
  29. Kvernland A, "Border-zone infarcts predict early recurrence in patients with large artery atherosclerotic subtype despite medical treatment", Stroke, 52, pp.AP605~ (2021)
  30. Sterne JA, "ROBINS-I : a tool for assessing risk of bias in non-randomised studies of interventions", BMJ, 355, pp.i4919~ (2016)
  31. Cumpston M, "Updated guidance for trusted systematic reviews : a new edition of the Cochrane handbook for systematic reviews of interventions", Cochrane Database Syst Rev, 10, pp.ED000142~ (2019)
  32. Egger M, "Bias in meta-analysis detected by a simple, graphical test", BMJ, 315, pp.629~634 (1997)
  33. Deeks JJ, "Cochrane Handbook for Systematic Reviews of Interventions Version 6" (2022), Cochrane
  34. Wabnitz AM, "Hemodynamic markers in the anterior circulation as predictors of recurrent stroke in patients with intracranial stenosis", Stroke, 50, pp.143~147 (2019)
  35. Psychogios K, "The pathophysiological mechanism is an independent predictor of long-term outcome in stroke patients with large vessel atherosclerosis", J Stroke Cerebrovasc Dis, 24, pp.2580~2587 (2015)
  36. Song X, "Incremental value of plaque enhancement in predicting stroke recurrence in symptomatic intracranial atherosclerosis", Neuroradiology, 62, pp.1123~1131 (2020)
  37. Raghuram K, "Relationship between stroke recurrence, infarct pattern, and vascular distribution in patients with symptomatic intracranial stenosis", J Neurointerv Surg, 10, pp.1161~1163 (2018)
  38. Harini P, "Infarct pattern as a predictor of outcome in symptomatic intracranial atherosclerotic disease", Int J Stroke, 15(Suppl 1), pp.488~ (2020)
  39. Caplan LR, "Impaired clearance of emboli (washout)is an important link between hypoperfusion, embolism, and ischemic stroke", Arch Neurol, 55, pp.1475~1482 (1998)
  40. Gao P, "Effect of stenting plus medical therapy vs medical therapy alone on risk of stroke and death in patients with symptomatic intracranial stenosis : the CASSISS randomized clinical trial", JAMA, 328, pp.534~542 (2022)

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