Long-term mortality and recurrent stroke risk among Chinese stroke patients with predominant intracranial atherosclerosis

Background and Purpose - The goal of this study was to document the long-term outcome of ischemic stroke patients in a population with predominant intracranial atherosclerosis and risk factors for a recurrent event. Methods - Intracranial and extracranial arteries of consecutive patients with acute ischemic stroke were studied prospectively with transcranial Doppler and duplex ultrasound. All patients were followed up regularly for the development of recurrent stroke, cardiac event, or death. Results - We included 705 patients with acute ischemic stroke, of whom 345 were documented ultrasonographically as having large-artery lesions. The follow-up period was up to 42 months ( mean, 28 +/- 5 months). One hundred seventeen patients (17%) died of any cause, and 199 (28%) suffered further cerebrovascular cardiac events. The 3.5-year cumulative mortality rate was 20.8%; for cerebrovascular event, it was 29.5%. The annual recurrent stroke rates during the first year were 10.9% for patients without vascular lesion, 17.1% for intracranial atherosclerosis only, and 24.3% for both intracranial and extracranial atherosclerosis; for the second year, the rates were 7.5%, 8.6%, and 7.7%, respectively. More occurrence of death ( log rank, 5.19; P = 0.02) or cerebrovascular event ( log rank, 9.68; P = 0.002) was found among patients with than those without vascular lesions. Patients with both intracranial and extracranial arterial lesions were at highest risk of death ( log rank, 9.64; P = 0.008) and cerebrovascular event ( log rank, 11.56; P = 0.003). When death and further vascular event were combined as poor outcomes in a Cox proportional-hazards regression model, number of abnormal arteries, advanced age, diabetes, atrial fibrillation, and previous stroke were significant predictors. Conclusions - Patients with intracranial atherosclerosis, especially coexisting extracranial carotid disease, are at higher risk of suffering death or further vascular event. Our findings provide important data for planning future randomized clinical trials for this high-risk group of stroke patients.