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Mechanisms of Recurrence in Subtypes of Ischemic Stroke - A Hospital-Based Follow-up Study

 Dong Hoon Shin  ;  Phil Hyu Lee  ;  Oh Young Bang 
 ARCHIVES OF NEUROLOGY , Vol.62(8) : 1232-1237, 2005 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Brain/blood supply ; Brain/pathology ; Brain/physiopathology ; Brain Ischemia/classification ; Brain Ischemia/diagnosis ; Brain Ischemia/etiology* ; Carotid Artery Diseases/complications* ; Carotid Artery Diseases/diagnosis ; Carotid Artery Diseases/physiopathology ; Diffusion Magnetic Resonance Imaging ; Female ; Follow-Up Studies ; Humans ; Infarction, Anterior Cerebral Artery/diagnosis ; Infarction, Anterior Cerebral Artery/etiology ; Infarction, Anterior Cerebral Artery/physiopathology ; Infarction, Middle Cerebral Artery/complications ; Infarction, Middle Cerebral Artery/diagnosis ; Infarction, Middle Cerebral Artery/physiopathology ; Intracranial Arteriosclerosis/complications* ; Intracranial Arteriosclerosis/diagnosis ; Intracranial Arteriosclerosis/physiopathology ; Intracranial Embolism/diagnosis ; Intracranial Embolism/etiology* ; Intracranial Embolism/physiopathology ; Magnetic Resonance Angiography ; Male ; Middle Aged ; Recurrence ; Stroke/classification ; Stroke/diagnosis ; Stroke/etiology*
BACKGROUND: Information on the mechanism of recurrent stroke may help physicians treating patients with ischemic stroke. However, the mechanisms of recurrence in each stroke subtype are not well known, especially in Asians.
OBJECTIVE: To compare the mechanisms of the index and recurrent stroke.
DESIGN: Analysis of data from a prospective acute stroke registry.
SETTING: University hospital.
PATIENTS: Using the clinical syndrome, diffusion-weighted imaging, and vascular studies, we divided 901 patients into 5 groups: large-artery atherosclerosis, cardioembolism, small-artery disease, parent-artery disease occluding the deep perforators, and no determined cause. The patients with large-artery atherosclerosis were subdivided into 2 groups: intracranial and extracranial.
MAIN OUTCOME MEASURES: The mechanisms of recurrent vascular events (strokes or coronary heart disease) in subtypes of ischemic stroke were compared.
RESULTS: Ninety-three recurrent vascular events (86 strokes and 7 instances of coronary heart disease) were evaluated. The pattern of recurrent stroke differed for the intracranial and extracranial groups; unlike the patients with intracranial large-artery atherosclerosis, recurrent strokes in the extracranial group were often unpredictable with respect to the site of recurrence and degree of preexisting stenosis. None of the patients in the extracranial group had recurrences that were caused by intracranial large-artery atherosclerosis or vice versa. In patients with small-artery disease and stroke with no determined cause, intracranial stenosis was often found at the time of recurrence.
CONCLUSIONS: From prognostic and therapeutic perspectives, patients with atherosclerosis should be divided into those with intracranial large-artery atherosclerosis and extracranial large-artery atherosclerosis. In addition, intracranial large-artery atherosclerosis may be important in the development of small-artery disease and stroke with no determined cause, especially in the population with a higher frequency of intracranial large-artery atherosclerosis.
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1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Lee, Phil Hyu(이필휴) ORCID logo https://orcid.org/0000-0001-9931-8462
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