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From the Stroke Branch (Drs. Kang, Latour, Chalela, and Warach) and Biostatistics Branch (Dr. Dambrosia), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; and Department of Neurology (Dr. Kang), University of Ulsan, Asan Medical Center, Seoul, South Korea.
Address correspondence and reprint requests to Dr. Steven Warach, Section on Stroke Diagnostics and Therapeutics, Stroke Branch, National Institute of Neurologic Disorders and Stroke, NIH, 10 Center Drive, Room B1D733, Bethesda, MD 20892–1063; e-mail: WarachS{at}ninds.nih.gov
Background: Based on previous observations of a high rate of ischemic lesion recurrence on diffusion-weighted imaging (DWI) within 1 week after an acute ischemic stroke, the authors hypothesized that silent new ischemic lesions are common between 1 week and 90 days after index stroke and that early lesion recurrence may be associated with late lesion recurrence.
Methods: The authors studied 80 acute ischemic stroke patients who had initial MRI performed within 48 hours, and follow-up scans at 5 days and at 30 or 90 days after onset. Early lesion recurrences were defined as new ischemic lesions on 5-day DWI, and late lesion recurrences were defined as those on 30- or 90-day DWI or fluid attenuation inversion recovery image. Early lesion recurrence occurring outside the initial perfusion deficit was termed distant lesion recurrence.
Results: Late lesion recurrence occurred in 26%, more frequently observed on 30-day MRI than 90-day MRI (p = 0.016). Early lesion recurrence (OR 4.0; 95% CI 1.3 to 11.7) and distant early lesion recurrence (OR 6.9; 95% CI 1.5 to 32.2) were independently associated with late lesion recurrence by multiple logistic regression analyses.
Conclusions: There may be a continued risk for recurrent ischemic lesions in the weeks following the clinically symptomatic stroke. Future studies are needed to investigate whether MRI-defined ischemic lesion recurrences predict subsequent clinical recurrence and thus may be a potential surrogate endpoint in stroke secondary prevention trials.
Received February 10, 2004. Accepted in final form August 2, 2004.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the December 28 issue to find the title link for this article.
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