Distribution and outcome of symptomatic stenoses and occlusions in patients with acute cerebral ischemia

Objective: To describe the distribution of steno-occlusive disease and the associated rate of recurrence in patients with acute cerebral ischemia. Design: An inception cohort was prospectively recruited after an index event and followed up to assess recurrent stroke and death up to 1 year after the event. Setting: Eleven German departments of neurology with acute stroke units. Patients: A total of 4157 patients who experienced an acute ischemic stroke or a transient ischemic attack and had complete cerebrovascular examination results. Followup information could be obtained in 85.3% of these patients. Results: Symptomatic vessel occlusions were associated with a high mortality rate and were found most often in the proximal internal carotid artery (6.5% of patients), the M1 segment of the middle cerebral artery (3.7%), and the vertebral artery (3.0%). Symptomatic stenosis of 50% to 99% of the internal carotid artery was found in 308 patients (7.4%), and 272 patients (6.5%) had symptomatic intracranial stenosis. The highest rates of recurrent stroke during the first 3 days occurred in patients with symptomatic carotid and intracranial occlusions. Overall, 82 (8.0%) of 1027 patients with symptomatic cerebrovascular disease experienced a recurrent stroke between day 4 and 1 year, but no significant differences in recurrent stroke rates could be found when comparing different locations of steno-occlusive disease. Conclusions: Our study provides representative data on the distribution and outcome of steno-occlusive disease in patients with acute cerebral ischemia. In contrast to prior studies in more selected populations, the rate of recurrent stroke in patients with symptomatic intracranial stenosis was not elevated compared with that of patients without steno-occlusive disease.