Intracranial occlusive arterial disease in Chinese stroke patients

The Chinese population consecutive patients admitted with acute cerebral ischemia were included. Pre-stroke disability (modified Rankin scale, MRS) and severity of index stroke (National Institute of Health Stroke Scale, NIHSS) were assessed at the acute phase. Stroke subtype was classified according to the Oxfordshire Community Stroke Project (OCSP) classification. Cerebral vasculature was evaluated with transcranial Doppler ultrasonography (TCD). Patients documented with symptomatic middle cerebral artery (MCA) occlusive disease were reexamined by TCD after 6 months. Clinical outcome such as death and a further vascular event (stroke recurrence or acute coronary syndrome) were recorded at 6 months after stroke and during a long-term follow-up. Functional condition was also assessed meanwhile by use of Barthel Index BI.; A total of 705 patients were included prospectively. Cerebral arterial occlusive lesions were identified ultrasonographically in 345 patients (49%), of whom 95% were identified with intracranial lesions, extracranial carotid lesion only accounted for 5%. Majority of patients (70%) had multiple lesions. At 6 months, 98 patients died or suffered a further vascular event, and 513 patients (73%) had a favorable functional recovery (BI scores > 80).; During a mean period of 25 months follow-up, 117 patients (17%) died and 199 (28%) suffered a further vascular event. Four hundred and fifty-six patients (65%) had a favorably functional outcome. Patients with vascular lesions had a poorer clinical outcome than those without. The number of vascular lesions remained a significant predictor for long-term clinical outcome [hazards ratio (HR) 1.17], as well as age (HR 1.03), diabetes (HR 1.33), and atrial fibrillation (HR 2.69). Further vascular event was strongly associated with long-term functional outcome (OR 3.11). Other predictors included age and NIHSS scores.; Six hundred and ninty-nine of 705 patients were classified with OCSP classification on admission. No difference of distribution of intracranial large artery abnormalities was found among OCSP stroke subtypes, but such stroke subtype was related to 6-month functional outcome. Patients with total anterior circulation infarct had the worst outcome.; Conclusions. Intracranial occlusive arterial disease is predominant in Chinese stroke patients. MCA is the most common lesion, progression of which could be a marker of clinical outcome. Presence and extent of intracranial occlusive arterial disease can predict early and long-term mortality and further vascular event. Lessening brain impairment of index stroke and secondary prevention of further vascular event could be benefit for early and long-term functional outcome.