Intracranial Occlusion in Cryptogenic Stroke Is Not Predictive of Recurrent Ischemic Stroke: A Propensity‐Score Matched Analysis of the Cardiac Abnormalities in Stroke Prevention and Risk of Recurrence Study
Year: 2025
Type: article
Abstract: BACKGROUND: Intracranial occlusions in embolic stroke of undetermined source are histopathologically similar to cardiac sources of embolism. Whether patients with embolic stroke of undetermined source and intracranial occlusion benefit from anticoagulation is unknown. METHODS: A multicenter retrospective cohort of adults with cryptogenic stroke was queried for patients with proximal or medium/distal vessel occlusion. The primary outcome was recurrent ischemic stroke, which was assessed in unadjusted and adjusted Cox proportional hazards models and repeated following 1:1 propensity score matching and biweight kernel density matching. RESULTS: Of the 2328 patients who were followed over a median of 1.31 years (interquartile range, 0.34-2.85), 999 (42.6%) had an intracranial occlusion. When compared with patients without an intracranial occlusion, those with an occlusion had fewer atherosclerotic vascular risk factors, more severe symptoms, and less severe cerebral microvascular disease. The rate of recurrent stroke was similar between patients with versus without an intracranial occlusion (6.8%/year [95% CI, 5.7-8.2] versus 7.0%/year [95% CI 6.0-8.1]; adjusted hazard ratio [HR], 1.09 [95% CI, 0.77-1.55]). There was no association between occlusion and recurrent stroke in the adjusted propensity score matching (HR, 1.01 [95% CI, 0.64-1.59]) or kernel density models (HR, 0.95 [95% CI, 0.62-1.45]). There was no interaction between occlusion and treatment with anticoagulation, sex, age, or high-risk sources of embolism for the primary outcome in the unmatched and matched analyses. CONCLUSIONS: Intracranial occlusion in patients with embolic stroke of undetermined source is not associated with a greater risk of recurrence when compared with patients without an intracranial occlusion. There was no difference in rate of recurrent stroke with anticoagulation when stratified by presence or absence of occlusion.
Authors: Matthew M. Smith, James R. Brorson, Elena Badillo Goicoechea, Mary Penckofer, Kelsey Eklund, Christoph Stretz, Christina M. Lineback, Farid Khasiyev, Deborah Kerrigan, Skylar Lewis, Hamid Ali, Hassan Aboul‐Nour, Adam de Havenon, Collin J. Culbertson, Emiliya Melkumova, Dinesh Jillella, Oana M. Dumitrascu, Parth Parikh, Charles Doolittle, Ian Yahnke, Anvitha Sathya, Samantha Brown, Jieun Kang, Anna Bowman, Mahan Shahrivari, Cheran Elangovan, Siddharth Sehgal, Kelly L. Sloane, Muhammad Alvi, Balaji Krishnaiah, Wayneho Kam, Sachin Kothari, Ahmad Abu Qdais, Mudassir Farooqui, Fadi Nahab, Gustavo Antezana Quintela, Richa Sharma, Neeharika Thottempudi, Simona Nedelcu, Franziska Herpich, Patrick Glover, Dalia Chahien, David S. Liebeskind, Guillermo Linares, Jean‐Philippe Daniel, Sami Al Kasab, Eesha Singh, Marissa D'Souza, Elizabeth Gaudio, Yasmin Aziz, Shadi Yaghi, Narendra Kala, Monica Sarkar, Eric D. Goldstein, Lucia Chen, Russel Van Coevering, Jesse M. Thon, Brian Stamm, Sean L. Thompson, James E. Siegler
Institutions: University of Chicago, Cooper University Hospital, University of Colorado Anschutz, University of Colorado Denver, Brown University, University of Michigan, Saint Louis University, Vanderbilt University Medical Center, Medical University of South Carolina, Trinity Health, Grady Memorial Hospital, Yale University, Lahey Hospital and Medical Center, Lahey Medical Center, Tufts University, Mayo Clinic, University of Cincinnati, Boston Medical Center, University of Tennessee Health Science Center, University of Pennsylvania, West Virginia University, Duke University Hospital, University of Iowa Hospitals and Clinics, Emory University, Dartmouth Health, Brigham and Women's Hospital, Christiana Care Health System, University of California, Los Angeles, Temple University, The Ohio State University Wexner Medical Center, VA Ann Arbor Healthcare System
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,810
Funder: National Institutes of Health
OpenAlex ID: W4414512643