Risk factors and clinical significance of post‐stroke incident ischemic lesions

Fang, Rong; Duering, Marco; Bode, Felix J.; Stösser, Sebastian; Meißner, Julius N.; Hermann, Peter; Liman, Thomas G.; Nolte, Christian H.; Kerti, Lucia; Ikenberg, Benno; Bernkopf, Kathleen; Glanz, Wenzel; Janowitz, Daniel; Wagner, Michael; Neumann, Katja; Speck, Oliver; Düzel, Emrah; Gesierich, Benno; Dewenter, Anna; Spottke, Annika; Waegemann, Karin; Görtler, Michael; Wunderlich, Silke; Zerr, Inga; Petzold, Gabor C.; Endres, Matthias; Georgakis, Marios K.; Dichgans, Martin (2024): Risk factors and clinical significance of post‐stroke incident ischemic lesions. Alzheimer's & Dementia, 20 (12). pp. 8412-8428. ISSN 1552-5260

Abstract

INTRODUCTION
While incident ischemic lesions (IILs) are not unusual on follow-up magnetic resonance imaging (MRI) following stroke, their risk factors and prognostic significance remain unknown.

METHODS
In a prospective multicenter study of 503 acute stroke patients, we assessed IILs on registered MRI images at baseline and 6 months, analyzing risk factors and clinical outcomes across 36 months.

RESULTS
At 6 months, 78 patients (15.5%) had IILs, mostly diffusion-weighted imaging-positive (72%) and clinically covert (91%). Older age and small vessel disease (SVD) lesions were baseline risk factors for IILs. IILs were associated with worse cognitive (beta for global cognition: −0.31, 95% confidence interval [CI]: −0.48 to −0.14) and functional outcomes (beta for modified Rankin scale [mRS]: 0.36, 95% CI: 0.14 to 0.58), and higher recurrent stroke risk (hazard ratio: 3.81, 95% CI: 1.35 to 10.69). IILs partially explained the relationship between SVD and poor cognition.

DISCUSSION
IILs are common and are associated with worse cognitive and functional outcomes and stroke recurrence risk. Assessing IILs following stroke might aid prognostication.

• Doc-Type: Article (LMU Hospital)
• Organisational unit (Faculties): 07 Medicine > Munich Cluster for Systems Neurology (SyNergy); 07 Medicine > Medical Center of the University of Munich > Institute for Stroke and Dementia Research (ISD)
• DFG subject classification of scientific disciplines: Life sciences
• DFG: Funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) - 491502892
• DFG: Funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) - 390857198