Background:Prior observations have shown that early recurrent ischemic lesions (ERILs) on diffusionweighted imaging occur frequently within the first week after an index stroke.Objective: To investigate differential patterns of ERILs among stroke subtypes, particularly intracranial largeartery atherosclerosis (IC-LAA).Design: Retrospective study.Setting: Tertiary university hospital. Patients:We included 133 patients who experienced an acute ischemic stroke and who underwent initial diffusion-weighted imaging within 24 hours and subsequent diffusion-weighted imaging within 7 days after onset, and whose stroke subtype was IC-LAA, extracranial LAA (EC-LAA), or cardioembolism (CE).Main Outcome Measure: Early recurrent ischemic lesions were defined as new ischemic lesions on follow-up diffusion-weighted imaging, separate from the index stroke lesion.Results: Early recurrent ischemic lesions were observed in the following proportions: 50.9% (28/55) in the IC-LAA group, 47.4% (9/19) in the EC-LAA group, and 44.1% (26/59) in the CE group. Early recurrent ischemic lesions in the IC-LAA group had the following characteristics: (1) they occurred mostly (27 [96.4%] of 28) in the pial area of the same vascular territory as the index stroke; (2) they were more frequently observed in a higher grade of stenosis than in milder stenosis (PϽ.001), whereas ERILs in the EC-LAA group were not related to the degree of stenosis; (3) they were not associated with subsequent recanalization, whereas ERILs in the CE group were mostly associated with subsequent recanalization (PϽ.001); and (4) they were more closely associated with clinical recurrence than in the EC-LAA or CE group (P=.02). Conclusion:Early recurrent ischemic lesions in the IC-LAA group are relatively frequent and have different patterns than in the EC-LAA or CE group.

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Background and Purpose-Early recurrent ischemic lesions (ERILs) on diffusion-weighted imaging after acute ischemic stroke have been suggested as a potential marker of early recurrent stroke. We hypothesized that biomarkers of inflammation or coagulation may be associated with the pathogenesis of ERILs and sought to investigate whether these biomarkers provide prognostic information on the risk of development of ERILs independently of clinical and imaging variables. Methods-This prospective study enrolled 153 consecutive patients with acute ischemic stroke who underwent diffusion-weighted imaging within 24 hours and subsequently at 5 days after onset and whose plasma or serum for biomarkers (C-reactive protein, fibrinogen, D-dimer, tissue plasminogen activator, and plasminogen activator inhibitor-1) were collected within 24 hours of onset. Those receiving thrombolysis or interventional therapy were excluded. ERILs were defined as new ischemic lesions on 5-day diffusion-weighted imaging separate from the index stroke lesions, which were not accompanied by subsequent recanalization. Results-ERILs