Abstract WMP73: Border Zone Infarct Pattern Predicts Early Recurrence In Symptomatic Intracranial Atherosclerotic Disease: A Systematic Review And Meta-analysis

Abstract

Introduction: Stroke secondary to intracranial atherosclerosis (ICAD) results in three distinct infarct patterns: (a) border zone infarcts (BZI) due to impaired distal perfusion (b) territorial infarcts due to distal plaque/thrombus embolization, and (c) perforator infarcts due to plaque progression. Previous studies indicate higher stroke recurrence in ICAD patients with BZI. Methods: This registered systematic review (CRD42021265230) comprised Medline and Web of Science search from inception to March 2022 for keywords (Intracranial Atherosclerosis OR Intracranial Stenosis) AND (Border zone OR Infarct Pattern) to identify papers and conference abstracts reporting initial infarct patterns and recurrence rates in patients with symptomatic ICAD. Sensitivity analyses were performed for studies including any BZI vs isolated BZI and those excluding posterior circulation strokes. The study outcome included neurological deterioration and/or stroke recurrence. For all outcome events, corresponding risk ratios (RR) and 95% confidence intervals (CI) were calculated. Risk of bias assessments will be presented. Results: Literature search yielded 4478 studies,11 met inclusion criteria (n=1315 patients, 354 with BZI, weighted proportions summarized in figure). The meta-analysis of these studies with moderate heterogeneity (I 2 =38.7%) demonstrated that RR of outcomes in BZI group compared to non-BZI group was 2.10 (95% CI 1.52-2.90). Limiting analysis to studies including any BZI, RR (and 95% CI) was 2.32 (1.58-3.40), and 3.25 (2.09-5.07) for studies only including anterior circulation strokes with low heterogeneity for both (I 2 =0%). A non-significantly high outcome rate was seen with isolated BZI (RR 2.29, 95% CI 0.94-5.62) but with moderate heterogeneity across studies (I 2 =70.25%). Conclusion: We demonstrate the presence of BZI secondary to symptomatic ICAD can be imaging biomarker to predict neurological deterioration and/or stroke recurrence.

Emergent Large Vessel Occlusion due to Intracranial Stenosis: Identification, Management, Challenges, and Future Directions

“…A meta-analysis demonstrated an association between BZI and recurrent risk in ICAS (relative risk, 2.10 [95% CI, 1.52–2.90]). 39…”

Hemodynamic Impairment of Blood Pressure and Stroke Mechanisms in Symptomatic Intracranial Atherosclerotic Stenosis

“…Intracranial atherosclerotic stenosis (ICAS) is emerging as a compelling cause of ischemic stroke and is associated with a poor prognosis. 1–3 The stroke mechanisms of symptomatic ICAS include artery-to-artery embolism, hypoperfusion, branch atheromatous disease, and large vessel occlusion, where artery-to-artery embolism is a result of plaque rupture and hypoperfusion is consequent to compromised blood flow, 4–6 which often coexist. 4 From a physics standpoint, hemodynamic impairment may have a significant influence on the stroke mechanism of atherosclerotic origin.…”

“…1–3 The stroke mechanisms of symptomatic ICAS include artery-to-artery embolism, hypoperfusion, branch atheromatous disease, and large vessel occlusion, where artery-to-artery embolism is a result of plaque rupture and hypoperfusion is consequent to compromised blood flow, 4–6 which often coexist. 4 From a physics standpoint, hemodynamic impairment may have a significant influence on the stroke mechanism of atherosclerotic origin. 7–9 For example, a heightened mechanical burden has the potential to induce deformation and mechanical disruption of plaque, while low perfusion pressure may lead to hypoperfusion.…”