Clinical and Imaging Predictors of Recurrent Ischemic Stroke: A Systematic Review and Meta-Analysis

Abstract

Background: Predictors of recurrent ischemic stroke are less well known in patients with a recent ischemic stroke than in patients with transient ischemic attack (TIA). We identified clinical and radiological factors for predicting recurrent ischemic stroke in patients with recent ischemic stroke. Methods: A systematic search in PubMed, Embase, Cochrane Library, and CINAHL was performed with the terms “ischemic stroke,” “predictors/determinants,” and “recurrence.” Quality assessment of the articles was performed and the level of evidence was graded for the articles included for the meta-analysis. Pooled risk ratios (RR) and heterogeneity (I²) were calculated using inverse variance random effects models. Results: Ten articles with high-quality results were identified for meta-analysis. Past medical history of stroke or TIA was a predictor of recurrent ischemic stroke (pooled RR 2.5, 95% CI 2.1–3.1). Small vessel strokes were associated with a lower risk of recurrence than large vessel strokes (pooled RR 0.3, 95% CI 0.1–0.7). Patients with stroke of an undetermined cause had a lower risk of recurrence than patients with large artery atherosclerosis (pooled RR 0.5, 95% CI 0.2–1.1). We found no studies using CT or ultrasound for the prediction of recurrent ischemic stroke. The following MRI findings were predictors of recurrent ischemic stroke: multiple lesions (pooled RR 1.7, 95% CI 1.5–2.0), multiple stage lesions (pooled RR 4.1, 95% CI 3.1–5.5), multiple territory lesions (pooled RR 2.9, 95% CI 2.0–4.2), chronic infarcts (pooled RR 1.5, 95% CI 1.2–1.9), and isolated cortical lesions (pooled RR 2.2, 95% CI 1.5–3.2). Conclusions: In patients with a recent ischemic stroke, a history of stroke or TIA and the subtype large artery atherosclerosis are associated with an increased risk of recurrent ischemic stroke. Predictors evaluated with MRI include multiple ischemic changes and isolated cortical lesions. Predictors of recurrent ischemic stroke concerning CT or ultrasound have not been published.

Readmissions and Mortality During the First Year After Stroke—Data From a Population-Based Incidence Study

“…Although seldom referred in the literature (1,4), the male sex was also an independent predictor of readmission/death in our study; this might be due to their proneness to recurrent IS (42); nevertheless, this hypothesis is not consensual in the literature (43).…”

Corneal confocal microscopy identifies greater corneal nerve damage in patients with a recurrent compared to first ischemic stroke

“…A recent study from China has shown that the incidence of recurrent stroke has increased 3-fold between 1992 and 2012 [3]. Age [4], dyslipidemia [5], smoking [6], diabetes, hypertension, homocysteine levels, atrial fibrillation [1], metabolic syndrome [7] and other risk factors [8][9][10] are associated with recurrent stroke. Indeed, a recent study has shown that hypertension, prior symptomatic stroke and chronic infarcts on MRI were independently associated with recurrent stroke and this also doubled the all-cause mortality [11].…”

Prediction of long-term recurrent ischemic stroke: the added value of non-contrast CT, CT perfusion, and CT angiography

“…In this study, we showed that recurrence risk estimation can be significantly improved by adding CT-derived predictors to a model incorporating clinical predictors. Although stroke subtype was a significant predictor of recurrent ischemic stroke in previous studies, this predictor did not have added value to the clinical prediction model in our study population [4]. The stroke etiology was determined using the TOAST classification [14].…”