Recurrent ischemic stroke is predicted by intracranial large artery stenosis identified by brain MRA: An observational study of 693 patients from Kaohsiung, Taiwan

Purpose: This study aimed to explore the incidence, severity and risk factors of recurrent stroke after stroke stratified by intracranial large artery stenosis (ILAS). Methods: This was an observational study of 693 ischemic stroke patients recruited in a medical center in southern Taiwan. ILAS was identified by MRA. Vascular risk factors, therapeutic conditions and stroke severity were evaluated prospectively. Risk of events was estimated by Kaplan-Meier survival analysis and adjusted for sex, age along with all the variables of interest by Cox proportional hazard models. Results: The mean observation period was 1.1 year with no lost to follow up. There were 57 (8.2%) patients suffered from recurrent ischemic stroke with 6 (10.5%) dead. Recurrent stroke rate was 2.3% within first month after stroke, 1.5% 31-90 days, 3% 91-365 days, and 1.2% within 365-730 days. Annual stroke recurrence was 8.6% (95%CI, 7.7-9.5). History of ischemic stroke (HR 2.793, 1.550-5.043) and ILAS (HR 2.193, 1.197-4.018) were associated with increased risk of recurrence. Conclusion: History of ischemic stroke along with ILAS related to the recurrence. Most of the recurrent stroke was mild in severity. Possibly due to the short interval of observation, recurrent stroke was not related to increased mortality.