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Symptomatic and asymptomatic intracranial atherosclerotic stenosis: 3 years’ prospective study

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Abstract

Background

Intracranial stenoses can cause TIA/ischaemic stroke. The purpose of this study was to assess vascular risk factors, clinical and imaging findings and outcome in Caucasians with intracranial stenosis under best prevention management.

Methods

In this prospective observational study (from 05/2012, to last follow-up 06/2017) we compared vascular risk factors, imaging findings and long-term outcome in Swiss patients with symptomatic versus asymptomatic intracranial atherosclerotic stenoses on best prevention management.

Results

62 patients were included [35.5% women, median age 68.3 years], 33 (53.2%) with symptomatic intracranial stenoses. Vascular risk factors (p = 0.635) and frequency of anterior circulation stenoses (66.7% vs. 55.2%; p = 0.354) did not differ between symptomatic and asymptomatic patients, but CT/MR-perfusion deficits in the territory of the stenosis (81.8% vs. 51.7%; p = 0.011) were more common in symptomatic patients. Outcome in symptomatic and asymptomatic patients at last follow-up was similar (mRS 0–1:66.7% vs. 75%;adjp = 0.937, mRS adjp-shift = 0.354, survival:100% vs. 96.4%;adjp = 0.979). However, during 59,417 patient follow-up days, symptomatic patients experienced more cerebrovascular events (ischaemic stroke or TIA) [37.5% vs. 7.1%;adjHR 7.58;adjp = 0.012], mainly in the territory of the stenosis [31.3% vs. 3.6%;adjHR 12.69;adjp = 0.019], more vascular events (i.e. ischaemic stroke/TIA/TNA and acute coronary/peripheral vascular events) [62.5% vs. 14.3%;adjHR 6.37;adjp = 0.001]) and more multiple vascular events (p-trend = 0.006; ≥ 2:37.5% vs. 10.7%;adj OR 5.37;adjp = 0.022) than asymptomatic patients.

Conclusions

Despite best prevention management, one in three patients with a symptomatic intracranial stenosis suffered a cerebrovascular event, three in five a vascular event and two in five ≥ 2 vascular events. There is an unmet need for more rigorous and effective preventive strategies in patients with symptomatic intracranial stenoses.

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Data availabilty

Raw data of all patients included in this study can be made available upon request to the corresponding author and after clearance by the local ethics committee.

Acknowledgements

We are grateful to the whole Bernese stroke team; who also contributed to SAISS.

Funding

The study was supported by a Swiss Heart Foundation Grant.

Author information

Authors and Affiliations

  1. Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland

    Urs Fischer, Aikaterini Galimanis, Xin Yan, Simon Jung, Marcel Arnold, Heinrich P. Mattle & Mirjam R. Heldner

  2. Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland

    Kety Hsieh-Meister, Frauke Kellner-Weldon, Johannes Kaesmacher, Marwan El-Koussy, Roland Wiest & Jan Gralla

  3. Stroke Centre, CHUV, Lausanne University Hospital, Lausanne, Switzerland

    Patrik Michel

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  1. Urs Fischer
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Contributions

MRH and UF take responsibility for the integrity of the data and the accuracy of the data analysis. Access to all the data: all co-authors. Study concept, design and supervision: MRH and UF. Acquisition of data: Bernese Stroke Team. Extraction of data and statistical analysis: MRH. Analysis and interpretation: MRH. Drafting of the manuscript: MRH and UF. Critical revision of the manuscript for important intellectual content: all listed co-authors.

Corresponding author

Correspondence to Mirjam R. Heldner.

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Conflicts of interest

U. Fischer, P. Michel and J. Gralla were supported by a Swiss Heart Foundation grant directly related to this study. All other co-authors report no disclosures directly related to this manuscript.

Ethical approval

The study was approved by the local ethics committee of the canton of Bern/Switzerland (KEK number: 127/11) and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Written informed consent was obtained from all patients. We complied with the principles of the Declaration of Helsinki and with the STROBE checklist.

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Fischer, U., Hsieh-Meister, K., Kellner-Weldon, F. et al. Symptomatic and asymptomatic intracranial atherosclerotic stenosis: 3 years’ prospective study. J Neurol 267, 1687–1698 (2020). https://doi.org/10.1007/s00415-020-09750-2

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