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Outcomes after ischemic stroke caused by intracranial atherosclerosis vs dissection

Authors
 Jaewon Shin  ;  Jong-Won Chung  ;  Moo Seok Park  ;  Hanul Lee  ;  Jihoon Cha  ;  Woo-Keun Seo  ;  Gyeong-Moon Kim  ;  Oh Young Bang 
Citation
 NEUROLOGY, Vol.91(19) : e1751-e1759, 2018 
Journal Title
 NEUROLOGY 
ISSN
 0028-3878 
Issue Date
2018
MeSH
Adult ; Aged ; Aneurysm, Dissecting/complications* ; Aneurysm, Dissecting/diagnostic imaging ; Female ; Humans ; Intracranial Arteriosclerosis/complications* ; Intracranial Arteriosclerosis/diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Prospective Studies ; Recovery of Function ; Stroke/diagnostic imaging ; Stroke/etiology*
Abstract
OBJECTIVE: To compare the outcomes between patients with nontraumatic intracranial arterial dissection (ICAD) and intracranial atherosclerotic stenosis (ICAS) using high-resolution MRI (HR-MRI). METHODS: We conducted a prospective study using HR-MRI in patients with acute symptomatic cerebrovascular disease due to intracranial occlusive disease and no dissection on luminal images. Patients were followed-up for 27.9 ± 19.3 months. We compared the functional outcome, recurrence, and changes in vascular status between patients with ICAD (dissection and no plaque on HR-MRI) and ICAS (atherosclerosis plaque on HR-MRI). RESULTS: We included 312 patients (mean age, 59.0 ± 14.2 years; men, 58.3%), of whom 113 had ICAD and 199 had ICAS. The functional outcome (as measured by modified Rankin Scale score) on the 90th day after symptom onset was not different between the groups, after adjusted for other factors (p = 0.095). However, recurrent ischemic cerebrovascular disease on the relevant vascular territory was lower in the ICAD group (7 patients, 6.2%) than in the ICAS group (37 patients, 18.6%). ICAD was a significant independent determinant of disease recurrence (hazard ratio, 0.43; 95% confidence interval, 0.19-0.98). Improvement in vascular stenosis on follow-up vascular studies was more frequently observed in ICAD (50.7%) than in ICAS (11.6%). ICAD was an independent determinant of vascular improvement (odds ratio, 7.94; 95% confidence interval, 3.32-19.01). CONCLUSION: Considering the high prevalence of ICAD in the patients with presumed ICAS and the differential outcomes between ICAD and ICAS, HR-MRI may be a useful diagnostic tool in this population.
Full Text
https://n.neurology.org/content/91/19/e1751.long
DOI
10.1212/WNL.0000000000006459
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Cha, Jihoon(차지훈)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/173007
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