Early ischemic lesion recurrence within a week after acute ischemic stroke

Ann Neurol. 2003 Jul;54(1):66-74. doi: 10.1002/ana.10592.


Previous observations suggested that multiple ischemic lesions on diffusion-weighted imaging (DWI) are common in acute stroke patients. We hypothesized that a source of these multiple lesions was the recurrence of ischemic lesions within a week after a clinically symptomatic stroke. We analyzed 99 acute ischemic stroke patients scanned within 6 hours of onset and at subsequent times within the first week. Ischemic lesion recurrence was defined as any new lesion separate from the index lesion. Recurrent lesions occurring outside initial perfusion deficit were termed 'distant lesion recurrence'. We estimated the hazard ratio (HR) of recurrence associated with clinical and imaging characteristics using log-rank test. Any lesion recurrence was found in 34%, with distant lesion recurrence in 15%, while clinical recurrence was evident in 2%. Initial multiple DWI lesions were associated with any lesion recurrence (HR, 2.83; 95% confidence interval [CI], 1.65-10.29; p = 0.002) and with distant lesion recurrence (HR, 5.99; 95% CI, 4.05-64.07; p < 0.0001). Large-artery atherosclerosis was the most frequent stroke subtype associated with any lesion recurrence (p = 0.026). These results may indicate a prolonged state of increased ischemic risk over the first week and suggest DWI as a possible surrogate measure for recurrent stroke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Anticoagulants / therapeutic use
  • Brain / blood supply*
  • Brain Ischemia / drug therapy
  • Brain Ischemia / etiology
  • Brain Ischemia / pathology*
  • Diffusion Magnetic Resonance Imaging
  • Female
  • Follow-Up Studies
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Intracranial Arteriosclerosis / complications
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors / therapeutic use
  • Recurrence
  • Registries
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Time Factors


  • Anticoagulants
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Platelet Aggregation Inhibitors