Recurrence risk in symptomatic intracranial stenosis treated medically in the real world

Yaghi, Shadi; Shu, Liqi; Goldstein, Eric; Chang, Allison; Kala, Narendra; Stretz, Christoph; Burton, Tina; Perelstein, Elizabeth; Furie, Karen L.; Jayaraman, Mahesh; Torabi, Radhmer; Moldovan, Krisztina; Havenon, Adam de; Khatri, Pooja; Gebregziabher, Mulugeta; Liebeskind, David S

doi:10.1016/j.jstrokecerebrovasdis.2023.107086

Cited by 2 publications

(2 citation statements)

References 25 publications

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“…Studies have shown that despite optimal medical management, some ICAS patients are at high risk of recurrent stroke. 9,13,33 Internal borderzone infarcts (BZIs) are classically described as beads of strings within the cortical BZI are in watershed territory between the middle and anterior cerebral artery supply zone (Figure 1D). A post hoc analysis from the SAMMPRIS trial (Stenting Versus Aggressive Medical Therapy for Intracranial Arterial Stenosis) showed that infarct pattern is a strong predictor of recurrent stroke in symptomatic ICAS patients.…”

Section: Hypoperfusion-hemodynamic Failurementioning

confidence: 99%

“…Despite aggressive medical management, the risk of recurrent stroke with ICAS remains high with ≈20% to 30% risk at 1 year, 12 particularly in the early time period after the initial event when at least nearly half of the recurrent events occur. 13 Over the past decade, clinical trials have improved our understanding of ICAS and shed light on the importance of identifying the group of patients who are likely to respond to medical management and patients who could benefit from endovascular interventions. In addition, the use of advanced imaging has improved our ability to identify these high-risk patients with early recurrent strokes who could be the target for a subsequent trial of early endovascular intervention.…”

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confidence: 99%

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

Al Kasab,

Nguyen,

Derdeyn

et al. 2024

Stroke

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This comprehensive literature review focuses on acute stroke related to intracranial atherosclerotic stenosis (ICAS), with an emphasis on ICAS-large vessel occlusion. ICAS is the leading cause of stroke globally, with high recurrence risk, especially in Asian, Black, and Hispanic populations. Various risk factors, including hypertension, diabetes, hyperlipidemia, smoking, and advanced age lead to ICAS, which in turn results in stroke through different mechanisms. Recurrent stroke risk in patients with ICAS with hemodynamic failure is particularly high, even with aggressive medical management. Developments in advanced imaging have improved our understanding of ICAS and ability to identify high-risk patients who could benefit from intervention. Herein, we focus on current management strategies for ICAS-large vessel occlusion discussed, including the use of perfusion imaging, endovascular therapy, and stenting. In addition, we focus on strategies that aim at identifying subjects at higher risk for early recurrent risk who could benefit from early endovascular intervention The review underscores the need for further research to optimize ICAS-large vessel occlusion treatment strategies, a traditionally understudied topic.

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Section: Hypoperfusion-hemodynamic Failurementioning

confidence: 99%

mentioning

confidence: 99%

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

Al Kasab,

Nguyen,

Derdeyn

et al. 2024

Stroke

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PSCK9 inhibitors reduced early recurrent stroke in patients with symptomatic intracranial atherosclerotic stenosis

Wu,

Zhang,

et al. 2024

J Neurol Neurosurg Psychiatry

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BackgroundSymptomatic intracranial atherosclerotic stenosis (ICAS) is prone to cause early recurrent stroke (ERS). Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors lower low-density lipoprotein cholesterol (LDL-C) levels and prevent cardiovascular events. This multicentre, hospital-based prospective cohort study was designed to investigate whether PCSK9 inhibitors would prevent ERS in patients with symptomatic ICAS.MethodsFrom 1 October 2020 to 30 September 2022, consecutive patients with acute ischaemic stroke attributed to ICAS admitted within 1 week after onset were enrolled and followed up for 1 month. Patients were divided into two groups, the PCSK9 inhibitors group receiving PCSK9 inhibitors add-on therapy, and the control group receiving statins and/or ezetimibe. The primary outcome was ERS. Cox proportional hazard models and Kaplan-Meier survival curve were used to estimate the association between PCSK9 inhibitors and ERS.ResultsAt the end of follow-up, the LDL-C levels were further lowered by PCSK9 inhibitors add-on therapy (n=232, from 3.06±1.16 mmol/L to 2.12±1.19 mmol/L) than statins and/or ezetimibe treatment (n=429, from 2.91±1.05 mmol/L to 2.64±0.86 mmol/L, p<0.001). The Kaplan-Meier survival curves showed that PCSK9 inhibitors add-on therapy significantly reduced ERS (5.59%, 24/429, vs 2.16%, 5/232; log-rank test, p=0.044). The multivariate Cox regression analysis revealed that, after adjusting for confounders with a p value less than 0.05 in univariate analysis or of particular importance, the HR was 0.335 (95% CI 0.114 to 0.986, p=0.047), compared with the control group.ConclusionsIn our study, PCSK9 inhibitors add-on therapy further reduced LDL-C levels and ERS in patients with symptomatic ICAS.

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Recurrence risk in symptomatic intracranial stenosis treated medically in the real world

Cited by 2 publications

References 25 publications

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

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

PSCK9 inhibitors reduced early recurrent stroke in patients with symptomatic intracranial atherosclerotic stenosis

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