Extracranial Color Duplex Sonography as a First Tool in the Prognosis after Thrombolytic Therapy

Abstract

Lower incidence of vascular events following small artery ischemic stroke Small artery infarction, which is particularly prevalent among Asians (1), carries a lower risk of recurrent stroke at one-month compared with other stroke subtypes, but long-term findings are inconsistent (2,3). Data on subsequent myocardial infarction risk after small artery stroke are limited. We compared the incidence of vascular events following ischemic stroke due to small artery disease vs. other etiologies among prospectively recruited Asian patients admitted to the Singapore General Hospital from 2005 to 2007. Telephone follow᎑up at a median of 30 months (IQR 24-34) masked to clinical information was obtained for 89% of the cohort. Among the 731 patients with known stroke etiology, 49% had small artery infarction, 38% had large artery infarction, 12% had cardioembolic, and 1% had other etiology. Figure 1 shows the cumulative incidence of subsequent vascular events. Using Cox regression adjusted for age, gender, hypertension, diabetes, hyperlipidemia, smoking, and atrial fibrillation, small artery infarction was associated with a lower incidence of recurrent stroke [hazard ratio (HR) 0•62; P = 0•047], myocardial infarction (HR 0•45; P = 0•031), vascular death (HR 0•18; P = 0•002), and composite vascular events (HR 0•59, P = 0•007) compared with nonsmall artery stroke. The lower risk of subsequent vascular events following small artery infarction may be explained by a differing underlying pathology from large artery and