- Patients with transient ischemic attack (TIA) or minor stroke who have isolated asymptomatic intracranial stenosis do not have elevated recurrence risk.
Why this matters
- Asymptomatic intracranial stenosis is a common finding of unknown clinical importance.
- Editorial highlights the "good news" that with modern medical therapy, "asymptomatic intracranial stenosis is one less thing to worry about.”
- 19.0% of patients had intracranial stenosis:
- 4.2% had symptomatic stenoses.
- 11.3% had asymptomatic stenoses.
- 3.4% had both.
- Prevalence of asymptomatic intracranial stenosis rose with age:
- From 3.8% for age for trend<.001>
- OR per decade of age: 1.96 (95% CI, 1.69-2.27).
- Unadjusted HR, 1.03 (95% CI, 0.49-2.17).
- Age-adjusted HR, 0.80 (95% CI, 0.38-1.71).
- 7-year risk for any recurrent ischemic stroke: 6.8%.
- Annualized risk for same-territory ischemic stroke: 0.59%.
- English population-based cohort study of 1579 patients (~95% white) with TIA or minor ischemic stroke (Oxford Vascular Study).
- Intracranial stenosis: ≥50% narrowing on imaging (MRI/MRA in two-thirds).
- Main outcome: prevalence, prognosis of asymptomatic intracranial stenosis.
- Funding: The Wellcome Trust; Wolfson Foundation; others.
- Findings may not apply to nonwhite patients, major stroke.
- Likely elevated medication adherence, risk factor control.
- Excluded patients without intracranial vascular imaging.