Intracranial arterial stenosis and recurrence in stroke patients with different risk stratifications by Essen stroke risk score

Figures & data

Figure 1. Flowchart of the patient inclusion process.

MIS: Minor ischemic stroke, TIA: Transient ischemic attack, CHANCE: The Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events trial, MRI: Magnetic resonance imaging, T1WI: T1 weighted-imaging, T2WI: T2 weighted-imaging, DWI: Diffusion weighted imaging, 3D-TOF-MRA: 3D time-of-flight magnetic resonance angiography.

Figure 2. Cumulative occurrence of recurrent stroke according to the presence of ICAS and ESRS using Kaplan – Meier survival analysis within 3 months. A: cumulative risk of recurrence at 3 months with or without ICAS in the low-risk group according to ESRS. B: cumulative risk of recurrence at 3 months with or without ICAS in the high-risk group according to ESRS. C: cumulative risk of recurrence at 3 months categorized by ICAS and ESRS (a: low-risk with ICAS; b: high-risk with ICAS; c: low-risk without ICAS; d: high-risk without ICAS).

Figure 3. Multivariate analysis of predictors for 3-month stroke recurrence based on the ESRS stratification.

Multivariate model included ESRS components, sex, days from event to enrolment, hours from onset to randomization, other medical history, body mass index, blood pressure, treatment group, concomitant medication, index event and ICAS. HR: Hazard ratio, CI: Confidence interval, ICAS: Intracranial arterial stenosis, MI: Myocardial infarction, PAD: Peripheral artery disease.

Table 1. Baseline characteristics in patients stratified by ESRS based on 3-month recurrence.

	Low risk (ESRS 0–2)			High risk (ESRS ≥3)
Characteristics	Recurrence (n = 54)	No Recurrence (n = 627)	P-value	Recurrence (n = 39)	No Recurrence (n = 369)	P-value
Male sex, no (%)	35(64.8%)	387(61.7%)	0.770	20(51.3%)	97(26.3%)	0.002
Days between the event and randomization (day)	0(0–1)	0(0–1)	0.456	0(0–1)	0(0–1)	0.771
Hours from onset to randomization	11.1(6.0–17.5)	12.0(7.2–19.5)	0.142	11.4(7.2–19.5)	12.0(7.2–20.0)	0.892
ESRS components, n (%)
Age			0.642			0.257
<65 years	38(70.4%)	476(75.9%)		12(30.8%)	93(25.2%)
65–75 years	14(25.9%)	129(20.6%)		18(46.2%)	142(38.5%)
>75 years	2(3.7%)	22(3.5%)		9(23.1%)	134(36.3%)
Hypertension	31(57.4%)	332(53.0%)	0.572	32(82.1%)	315(85.4%)	0.636
Diabetes	4(7.4%)	63(10.1%)	0.811	17(43.6%)	143(38.8%)	0.606
Myocardial infarction	0(0%)	1(0.2%)	1.000	0(0%)	18(4.9%)	0.239
Other heart diseases	0(0%)	14(2.2%)	0.617	5(12.8%)	59(16.0%)	0.817
Peripheral vascular disease	0(0%)	0(0%)	NE	0(0%)	0(0%)	NE
Smoker	21(38.9%)	224(35.7%)	0.659	18(46.2%)	195(52.9%)	0.501
A history of ischemic stroke or TIA	6(11.1%)	37(5.9%)	0.223	21(53.8%)	155(42.0%)	0.156
Medical history, no. (%)
Dyslipidemia	3(5.6%)	59(9.4%)	0.463	9(23.1%)	66(17.9%)	0.393
Current drinker	18(33.3%)	179(28.6%)	0.439	15(38.5%)	123(33.3%)	0.594
Heart failure	0(0%)	4(0.6%)	1.000	3(7.7%)	12(3.3%)	0.164
Atrial fibrillation	0(0%)	2(0.3%)	1.000	4(10.3%)	15(4.1%)	0.097
Body-mass index	25.0(22.8–26.7)	24.2(22.4–26.1)	0.347	25.4(21.9–27.8)	24.5(22.5–26.1)	0.003
Blood pressure (mm Hg)
Systolic	158.5(140.0–171.0)	150.0(140.0–165.0)	0.492	160.0(150.0–177.0)	150.0(140.0–168.0)	0.045
Diastolic	90.0(80.0–100.0)	90.0(80.0–100.0)	0.975	90.0(85.0–100.0)	85.0(78.0–95.0)	<0.001
Treatment group, no. (%)			0.888			0.183
Aspirin	27(50.0%)	322(51.4%)		24(61.5%)	185(50.1%)
Clopidogrel with aspirin	27(50.0%)	305(48.6%)		15(38.5%)	184(49.9%)
Concomitant medication
PPI	1(1.9%)	7(1.1%)	0.488	2(5.1%)	4(1.1%)	0.106
Anti-hypertensive	22(40.7%)	250(40.2%)	1.000	16(41.0%)	167(45.6%)	0.616
Anti-diabetes	11(20.4%)	54(8.7%)	0.013	10(25.6%)	72(19.7%)	0.402
Lipid-lowering	22(40.7%)	323(51.9%)	0.121	18(46.2%)	208(56.8%)	0.236
Index event			0.091			0.126
TIA	7(13.0%)	150(23.9%)		6(15.4%)	102(27.6%)
Minor stroke	47(87.0%)	477(76.1%)		33(84.6%)	267(72.4%)
Intracranial arterial stenosis	34(63.0%)	229(36.5%)	<0.001	26(66.7%)	192(52.0%)	0.093

ESRS: Essen Stroke Risk score, TIA: Transient ischemic attack, NE: Not estimable, PPI: Proton pump inhibitor.

Table 2. Baseline characteristics in patients stratified by ESRS based on 12–month recurrence.

	Low risk (ESRS 0–2)			High risk (ESRS ≥3)
Characteristics	Recurrence (n = 60)	No Recurrence (n = 621)	P-value	Recurrence (n = 46)	No Recurrence (n = 362)	P-value
Male sex, no. (%)	39(65.0%)	383(61.7%)	0.677	25(54.4%)	266(73.5%)	0.009
Days event to randomization – day	0(0–1)	0(0–1)	0.899	0(0–1)	1(0–1)	0.070
Hours from onset to randomization	11.1(5.5–17.5)	12.0(7.2–19.3)	0.171	13.6(7.8–20.5)	11.8(7.1–20.0)	0.466
ESRS components, n (%)
Age			0.897			0.394
<65 years	44(73.3%)	470(75.7%)		13(28.3%)	92(25.4%)
65–75 years	14(23.3%)	129(20.8%)		21(45.7%)	139(38.4%)
>75 years	2(3.3%)	22(3.5%)		12(26.1%)	131(36.2%)
Hypertension	35(58.3%)	328(52.8%)	0.498	37(80.4%)	310(85.6%)	0.379
Diabetes	5(8.3%)	62(10.0%)	0.823	20(43.5%)	140(38.7%)	0.526
Myocardial infarction	0(0%)	1(0.2%)	1.000	1(2.2%)	17(4.7%)	0.707
Other heart diseases	0(0%)	14(2.3%)	0.625	6(13.0%)	58(16.0%)	0.829
Peripheral vascular disease	0(0%)	0(0%)	NE	0(0%)	0(0%)	NE
Smoker	24(40.0%)	221(35.6%)	0.486	22(47.8%)	191(52.8%)	0.536
A history of ischemic stroke or TIA	6(10.0%)	37(6.0%)	0.341	23(50.0%)	153(42.2%)	0.318
Medical history no. (%)
Dyslipidemia	4(6.7%)	58(9.3%)	0.641	12(26.1%)	63(17.4%)	0.159
Current drinker	20(33.3%)	177(28.5%)	0.457	18(39.1%)	120(33.2%)	0.414
Heart failure	0(0%)	4(0.6%)	1.000	3(6.5%)	12(3.3%)	0.233
Atrial fibrillation	0(0%)	2(0.3%)	1.000	5(10.9%)	14(3.9%)	0.051
Body mass index	25.2(22.8–26.7)	24.2(22.4–26.1)	0.311	25.3(21.9–27.7)	24.5(22.5–26.1)	0.619
Blood pressure (mm Hg)
Systolic	150.0(140.0–166.5)	150.0(140.0–166.0)	0.997	160.0(150.0–175.0)	150.0(140.0–168.0)	0.127
Diastolic	90.0(80.0–99.5)	90.0(80.0–100.0)	0.809	90.0(83.0–100.0)	85.0(78.0–95.0)	0.008
Treatment group, no. (%)			0.893			0.348
Aspirin	30(50.0%)	319(51.4%)		27(58.7%)	182(50.3%)
Clopidogrel with aspirin	30(50.0%)	302(48.6%)		19(41.3%)	180(49.7%)
Concomitant medication
PPI	1(1.7%)	7(1.1%)	0.527	2(4.4%)	4(1.1%)	0.141
Anti-hypertensive	24(40.0%)	248(40.3%)	1.000	17(37.0%)	166(46.2%)	0.272
Anti-diabetes	11(18.3%)	54(8.8%)	0.035	11(23.9%)	71(19.8%)	0.559
Lipid-lowering	24(40.0%)	321(52.1%)	0.080	20(43.5%)	206(57.4%)	0.084
Index event			0.148			0.076
TIA	9(15.0%)	148(23.8%)		7(15.2%)	101(27.9%)
Minor stroke	51(85.0%)	473(76.2%)		39(84.8%)	261(72.1%)
Intracranial arterial stenosis	36(60.0%)	227(36.6%)	<0.001	32(69.6%)	186(51.4%)	0.027

ESRS: Essen Stroke Risk score, TIA: Transient ischemic attack, NE: Not estimable, PPI: Proton pump inhibitor.

Data availability statement

The datasets analyzed during the current study are available from the corresponding author upon reasonable request.