| Objective:To analyze the role of MR imaging in predicting recurrent stroke and sought to evaluate and identify which subsets of patients are at risk for recurrent events.Materials and Methods:57patients who were admitted with1st ever ischemic stroke as found out by MRI from March,2012to August2013were enrolled.19patients were assigned to the recurrence group who had their second acute ischemic stroke as confirmed on DWI scans of the second MRI scan at least1month after the initial stroke. Patients with worsening conditions or with new adjacent focal points of stroke found in the DWI scans before1month were attributed to stroke progression rather than stroke recurrence. Rest of the38patients were followed for at least1year by phone and were not found to have any clinical neurological complications after their initial stroke. These38patients were assigned to the control group. A total of9parameters were analyzed between the two groups which were as follows:Size of the acute lesion, Number of acute lesion, Location of the acute lesion, Artery supplying the area around the acute lesion, Circle Of Willis (Complete/Incomplete), Intracranial Large Artery Stenosis (+/-), Extent of Leukoaraiosis/White Matter Lesion ICA, Atherosclerotic plague (+/-) and Clinical History of Diabetes Mellitus and Hypertension. T1WI, T2WL DWI, ADC scans of MRI, MRA scan and ICA CDUS data of all the57patients were analyzed and compared. MRA data was unavailable for3of the recurrence group and5of the control group patients while Doppler Ultrasound report was unavailable for2of the recurrence group and8of the control group patients. SPSS17.0software package was used for statistical analysis with having statistics differences when P<0.05.Results:The mean age of recurrence group at the time of initial event was9years higher than the control group. Independent sample t-test was done and we found that the2groups were significantly different (t=3.2, F=0.002). Age was then analyzed according age groups and we found that the recurrence and control groups were significantly different (P=0.003).66.7%(12/18) of the patients older than65years had recurrence. The two groups were not statistically different (F>0.05) based on the number of acute lesions, location of the acute lesion, anatomy of Circle of Willis, ICA Atherosclerotic plague and Clinical History of Diabetes Mellitus&Hypertension. In regard to the Artery supplying the area around the acute lesion, the two groups were found to be statistically significant (P=0.013). We found out that if the MCA territory (85.7%,6/7times there was a recurrence when lesion was in MCA territory) was involved there was a higher chance of recurrence. However, only1out of the13patients (7.7%) had recurrence if the posterior circulation arteries were involved. While comparing ILAS the two groups were found to be statistically significant (P=0.000). Stenosis of>50%was found in87.5%(14/16) in the recurrence group as compared to27.3%(9/33) in the control group. Based on the extent of WML the two groups were found to be statistically different (P=0.000). There was no patient found with grade0in recurrence group as opposed to19/38(50%) found with grade0in the control group. Grade1, grade2and grade3were present in10.5%(2/19),47.4%(9/19) and842.1%(8/19) respectively in the recurrence group, while in control group it was21.1%(8/38),21.1%(8/38) and7.9%(3/38). Multivariate analysis of all the four significant risk factors was done. Using multivariate analysis, we found that the artery supplying the area around the lesion (OR,2.057;95%CI,1.079-3.922; P=0.029) and the extent of WML severity (OR,0.143;95%CI,0.042-0.480; P=0.002) were independent risk factors.Conclusion:The chance of recurrence was concluded to depend on the4factors namely the age (>65years) of the patient, artery supplying the area around the acute lesion, the presence of ILAS>50%and the extent of WML severity (grade2or3) at the time of initial stroke. The artery supplying the area around the acute lesion and the extent of WML severity were found to be independent risk factors for recurrence. For the artery supplying the area around the acute lesion risk factor, we concluded that patients with MCA territory infarct had a greater chance of recurrence while patients with posterior circulation territory infarcts had the least. So, based on the four evidences, we concluded that an older patient with an acute ischemic stroke found in MCA territory and having intracranial stenosis>50%and grade3WML is at a higher risk for recurrence. 1.2.4.9Clinical History(DM,HTN)…………………………………161.2.3Multivariate Analysis…………………………………………………171.3.Dicussion……………………………………………………………………18Conclusion………………………………………………………………………27References…………………………………………………………………………28Images………………………………………………………………………35Literature Review…………………………………………………………………43Acknowledgement………………………………………………………………55... |
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