Hypoperfusion Distal to Anterior Circulation Intracranial Atherosclerosis is Associated with Recurrent Stroke

J Neuroimaging. 2020 Jul;30(4):468-470. doi: 10.1111/jon.12710. Epub 2020 Jun 24.


Background and purpose: In patients with symptomatic vertebrobasilar intracranial atherosclerotic disease (ICAD), impaired distal flow predicts recurrent stroke, but limited data exist on the association between perfusion status and recurrent stroke in anterior circulation ICAD.

Methods: This is a retrospective study of patients hospitalized for symptomatic ICAD with 50-99% stenosis of the intracranial carotid or middle cerebral artery. The primary outcome is recurrent symptomatic ischemic stroke in the territory of the artery with ≥50% stenosis within 90 days. The primary predictor is distal hypoperfusion on magnetic resonance (MR) or computed tomography (CT) perfusion, defined as a ≥15 mL volume of territory of the symptomatic artery with Tmax >6 seconds.

Results: Fifty patients met inclusion criteria, including 15 (30%) with recurrent stroke and 15 (30%) with distal hypoperfusion. Distal hypoperfusion was present in 10 of 15 (66.7%) with recurrent stroke versus 5 of 35 (14.3%) without recurrent stroke (P < .001). The hazard ratio for recurrent stroke in patients with distal hypoperfusion was 6.80 (95% confidence interval [CI] 2.31-20.0).

Conclusion: Distal hypoperfusion in acutely symptomatic ICAD with 50-99% stenosis is associated with stroke recurrence. Distal hypoperfusion could be used to enrich future trials of secondary stroke prevention in ICAD patients.

Keywords: Acute ischemic hemorrhage; intracranial atherosclerosis; perfusion imaging; recurrent stroke.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carotid Artery, Internal / diagnostic imaging*
  • Female
  • Humans
  • Intracranial Arteriosclerosis / complications
  • Intracranial Arteriosclerosis / diagnostic imaging*
  • Ischemic Stroke / diagnostic imaging*
  • Ischemic Stroke / etiology
  • Male
  • Middle Aged
  • Middle Cerebral Artery / diagnostic imaging*
  • Perfusion Imaging
  • Recurrence
  • Retrospective Studies