PDF herunterladen
CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2018; 76(10): 649-653
DOI: 10.1590/0004-282X20180095
Article

Stroke recurrence in the different subtypes of ischemic stroke. The importance of the intracranial disease

Recorrência nos diferentes subtipos de acidente vascular cerebral isquêmico. A importância da doença intracraniana.
Marcos C Lange
1   Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brasil;
,
Gustavo Ribas
1   Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brasil;
,
Valeria Scavasine
1   Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brasil;
,
Renata Dal-Prá Ducci
1   Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brasil;
,
Danielle C. Mendes
1   Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brasil;
,
Viviane de Hiroki Flumignan Zétola
1   Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brasil;
,
Norberto Cabral
2   Universidade da Região de Joinville, Departamento de Medicina, Joinville SC, Brasil;
,
Tatjana Rundek
3   University of Miami, Miller School of Medicine, Department of Neurology, Miami, FL, USA.
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

ABSTRACT

The aim of the study was to analyze the long-term recurrence rate in patients with a first-ever ischemic stroke secondary to intracranial large artery atherosclerosis (LAA) in a Brazilian population. Methods: All stroke patients admitted to the hospital between October 2012 and September 2015 were evaluated. The stroke mechanism subtypes were classified as cardioembolism, LAA, small-vessel occlusion, other determined etiologies, and stroke of undetermined etiology. Results: The 359 first-ever ischemic stroke patients were followed up for a mean time of 21.6 ± 15.1 months. The LAA intracranial (38.9%) and extracranial (24.6%) stroke patients presented with a higher stroke recurrence. Intracranial LAA [HR, 10.2 (3.6–29.1); p < 0.001] and extracranial LAA [HR, 5.05 (1.79–14.2); p = 0.002] were the only conditions to show positive correlation with the recurrence rate, after adjusting for risk factors, thrombolysis, and National Institutes of Health Stroke Scale score at admission. Conclusion: Intracranial LAA presents a higher incidence of recurrence of ischemic stroke when compared with other etiologies in a Southern Brazilian population.

RESUMO

O objetivo do presente estudo é analisar a taxa de recorrência a longo prazo em pacientes com o primeiro AVCi secundário à aterosclerose de grande artéria intracraniana em uma amostra brasileira. Métodos: Pacientes admitidos entre outubro de 2012 e setembro de 2015 foram analisados. Os subtipos do mecanismo de AVC foram classificados como cardioembolismo, aterosclerose de grandes artérias, oclusão de pequenos vasos, outras etiologias determinadas e AVCi de causa indeterminada. Resultados: Foram avaliados 359 pacientes com primeiro AVCi. O tempo médio de seguimento foi de 21,6 ± 15,1 meses. A aterosclerose de grande artéria, intracraniana (38,9%) e extracraniana (24,6%), apresentou a maior taxa de recorrência. A aterosclerose de grande artéria intracraniana [HR, 10,2 (3,6–29,1); p < 0,001] e extracraniana [HR, 5,05 (1,79–14,2); p = 0,002] demonstraram correlação positiva com a taxa de recorrência, após o ajuste para fatores de risco, trombólise e gravidade dos sintomas na admissão. Conclusão: A aterosclerose de grande artéria, tanto intracraniana como extracraniana, apresenta maior recorrência comparado aos outros mecanismos de AVCi em uma amostra do Sul do Brasil.

Keywords:

stroke - atherosclerosis - recurrence - risk factors

Palavras-chave:

Acidente vascular cerebral - aterosclerose - recidiva - fatores de risco


Publikationsverlauf

Eingereicht: 27. März 2018

Angenommen: 26. Juni 2018

Artikel online veröffentlicht:
22. August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 White H, Boden-Albala B, Wang C, Elkind MS, Rundek T, Wright CB et al. Ischemic stroke subtype incidence among whites, blacks, and Hispanics: the Northern Manhattan Study. Circulation. 2005 Mar;111(10):1327-31. https://doi.org/10.1161/01.CIR.0000157736.19739.D0
  • 2 Arenillas JF, Molina CA, Chacón P, Rovira A, Montaner J, Coscojuela P et al. High lipoprotein (a), diabetes, and the extent of symptomatic intracranial atherosclerosis. Neurology. 2004 Jul;63(1):27-32. https://doi.org/10.1212/01.WNL.0000132637.30287.B4
  • 3 Weimar C, Goertler M, Harms L, Diener HC. Distribution and outcome of symptomatic stenoses and occlusions in patients with acute cerebral ischemia. Arch Neurol. 2006 Sep;63(9):1287-91. https://doi.org/10.1001/archneur.63.9.1287
  • 4 Wong KS, Huang YN, Gao S, Lam WW, Chan YL, Kay R. Intracranial stenosis in Chinese patients with acute stroke. Neurology. 1998 Mar;50(3):812-3. https://doi.org/10.1212/WNL.50.3.812
  • 5 De Silva DA, Woon FP, Lee MP, Chen CP, Chang HM, Wong MC. South Asian patients with ischemic stroke: intracranial large arteries are the predominant site of disease. Stroke. 2007 Sep;38(9):2592-4. https://doi.org/10.1161/STROKEAHA.107.484584
  • 6 Kasner SE, Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS et al. Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis. Circulation. 2006 Jan;113(4):555-63. https://doi.org/10.1161/CIRCULATIONAHA.105.578229
  • 7 Mazighi M, Tanasescu R, Ducrocq X, Vicaut E, Bracard S, Houdart E et al. Prospective study of symptomatic atherothrombotic intracranial stenoses: the GESICA study. Neurology. 2006 Apr;66(8):1187-91. https://doi.org/10.1212/01.wnl.0000208404.94585.b2
  • 8 Ay H, Furie KL, Singhal A, Smith WS, Sorensen AG, Koroshetz WJ. An evidence-based causative classification system for acute ischemic stroke. Ann Neurol. 2005 Nov;58(5):688-97. https://doi.org/10.1002/ana.20617
  • 9 Feldmann E, Wilterdink JL, Kosinski A, Lynn M, Chimowitz MI, Sarafin J et al. The stroke outcomes and neuroimaging of intracranial atherosclerosis (SONIA) trial. Neurology. 2007 Jun;68(24):2099-106. https://doi.org/10.1212/01.wnl.0000261488.05906.c1
  • 10 Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, Frankel MR et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med. 2005 Mar;352(13):1305-16. https://doi.org/10.1056/NEJMoa043033
  • 11 Instituto Brasileiro de Geografia e Estatística - IBGE. Censo 2010. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2013 [cited 2013 May 20]. Available from: https://www.censo2010.ibge.gov.br/apps/mapa/
  • 12 World Health Organization – WHO. Section 1: Introduction, 1-4. 2006 [cited 2017 May]. Available from: http://www.who.int/chp/steps/stroke/manual/en/
  • 13 Weber R, Kraywinkel K, Diener HC, Weimar C. Symptomatic intracranial atherosclerotic stenoses: prevalence and prognosis in patients with acute cerebral ischemia. Cerebrovasc Dis. 2010;30(2):188-93. https://doi.org/10.1159/000317107
  • 14 Petty GW, Brown RD Jr, Whisnant JP, Sicks JD, O’Fallon WM, Wiebers DO. Ischemic stroke subtypes : a population-based study of functional outcome, survival, and recurrence. Stroke. 2000 May;31(5):1062-8. https://doi.org/10.1161/01.STR.31.5.1062
  • 15 Kolominsky-Rabas PL, Weber M, Gefeller O, Neundoerfer B, Heuschmann PU. Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study. Stroke. 2001 Dec;32(12):2735-40. https://doi.org/10.1161/hs1201.100209
  • 16 Arenillas JF. Intracranial atherosclerosis: current concepts. Stroke. 2011 Jan;42(1 Suppl):S20-3. https://doi.org/10.1161/STROKEAHA.110.597278
  • 17 O’Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010 Jul;376(9735):112-23. https://doi.org/10.1016/S0140-6736(10)60834-3
  • 18 Marrone LCP, Diogo LP, Oliveira FM, Trentin S, Scalco RS, Almeida AG et al. Risk factors among stroke subtypes in Brazil. J Stroke Cerebrovasc Dis. 2013 Jan;22(1):32-5. https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.05.022
  • 19 Bushnell CD, Zimmer LO, Pan W, Olson DM, Zhao X, Meteleva T et al. Persistence with stroke prevention medications 3 months after hospitalization. Arch Neurol. 2010 Dec;67(12):1456-63. https://doi.org/10.1001/archneurol.2010.190
  • 20 Derdeyn CP, Chimowitz MI, Lynn MJ, Fiorella D, Turan TN, Janis LS et al. Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial. Lancet. 2014 Jan;383(9914):333-41. https://doi.org/10.1016/S0140-6736(13)62038-3
  • 21 Liu L, Wong KS, Leng X, Pu Y, Wang Y, Jing J et al. Dual antiplatelet therapy in stroke and ICAS: subgroup analysis of CHANCE. Neurology. 2015 Sep;85(13):1154-62. https://doi.org/10.1212/WNL.20180095201800951972
  • 22 Cardena MM, Ribeiro-Dos-Santos A, Santos S, Mansur AJ, Pereira AC, Fridman C. Assessment of the relationship between self-declared ethnicity, mitochondrial haplogroups and genomic ancestry in Brazilian individuals. PLoS One. 2013 Apr;8(4):e62005. https://doi.org/10.1371/journal.pone.0062005
  • 23 Pena SD, Di Pietro G, Fuchshuber-Moraes M, Genro JP, Hutz MH, Kehdy FS et al. The genomic ancestry of individuals from different geographical regions of Brazil is more uniform than expected. PLoS One. 2011 Feb;6(2):e17063. https://doi.org/10.1371/journal.pone.0017063
  • 24 Gutierrez J, Elkind MS, Virmani R, Goldman J, Honig L, Morgello S et al. A pathological perspective on the natural history of cerebral atherosclerosis. Int J Stroke. 2015 Oct;10(7):1074-80. https://doi.org/10.1111/ijs.12496
  • 25 Lau AY, Wong EH, Wong A, Mok VC, Leung TW, Wong KS. Significance of good collateral compensation in symptomatic intracranial atherosclerosis. Cerebrovasc Dis. 2012;33(6):517-24. https://doi.org/10.1159/000337332
  • 26 López-Cancio E, Mathus MG, Romano JG, Liebeskind DS, Prabhakaran S, Turan TN et al. Infarct patterns, collateral and likely causative mechanisms of stroke in symptomatic intracranial atherosclerosis. Cerebrovasc Dis 2014;37(6):417-22. https://doi.org/10.1159/000362922