{
  "abstract": "Background Intracranial atherosclerotic disease (ICAD) has a high risk of symptomatic recurrence. We investigated the prevalence of same-territory chronic infarcts among symptomatic ICAD patients, and their ability to discriminate between absence and presence of future same-territory ischaemic events.Methods In a retrospective analysis of prospectively collected data from two Australian stroke centres, patients were followed for recurrent ischaemia over 12 months. Ability to discriminate between absence and presence of recurrent stroke/TIA (Area-under-curve (AUC) in receiver-operating-characteristic analysis) and degree of model fit (Bayesian information criterion (BIC)) were compared for prognostic characteristics of chronic same-territory stroke, >70% stenosis and CT-perfusion hypoperfusion.Results From 2019 to 2020, 135 patients had symptomatic ICAD, mean age 73.8 (SD±13.2) and 57/135 (42%) female, of whom 29/135 (21%) had chronic same-territory infarcts. Over a 12-month follow-up period, recurrent cerebrovascular events occurred in 9/29 (31%) patients with, and in 11/106 (10%) without, chronic same-territory stroke (OR 3.9 95% CI 1.4 to 10.6, p=0.008). In discrimination and model fit analysis, BIC indicated strong evidence for improved model fit, for same-territory chronic infarction (AUC 0.64) vs >70% stenosis (AUC 0.58, p=0.59; BIC difference 4.7). In n=99 with CT-perfusion, chronic infarct showed better fit than CT-perfusion hypoperfusion (0.64 vs 0.61, p=0.79; BIC difference 2.8). Chronic infarct alone also outperformed all combinations of chronic infarct, hypoperfusion and >70% stenosis in model fit.Conclusions Chronic same-territory infarcts are common among patients presenting with symptomatic ICAD and can better discriminate future same-territory ischaemic cerebrovascular events over a 12-month period than stenosis>70% and hypoperfusion on CTP.",
  "authors": [
    {
      "affiliations": [
        "Neurology, Austin Health, Heidelberg, Victoria, Australia"
      ],
      "name": "Davor Pavlin Premrl"
    },
    {
      "affiliations": [
        "Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Benjamin Churilov"
    },
    {
      "affiliations": [
        "Department of Neurology, Austin Health, Heidelberg, Victoria, Australia",
        "Stroke Division, Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia"
      ],
      "name": "Vincent Thijs"
    },
    {
      "affiliations": [
        "Royal Adelaide Hospital, Adelaide, South Australia, Australia"
      ],
      "name": "Michael Waters"
    },
    {
      "affiliations": [
        "Northern Hospital Epping, Epping, Victoria, Australia"
      ],
      "name": "Mei Yan Ngun"
    },
    {
      "affiliations": [
        "Royal Melbourne Hospital Department of Surgery, Parkville, Victoria, Australia"
      ],
      "name": "Nawaf Yassi"
    },
    {
      "affiliations": [
        "Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia"
      ],
      "name": "Leonid Churilov"
    },
    {
      "affiliations": [
        "Liverpool Hospital, Liverpool, New South Wales, Australia"
      ],
      "name": "Mark William Parsons"
    },
    {
      "affiliations": [
        "Radiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia"
      ],
      "name": "Peter J Mitchell"
    },
    {
      "affiliations": [
        "The Royal Melbourne Hospital, Melbourne, Victoria, Australia"
      ],
      "name": "Bruce Campbell"
    }
  ],
  "title": "Same-territory chronic infarcts are common in intracranial atherosclerosis and are associated with future recurrence",
  "uid": "86f5458f-9361-53ab-9e37-a8201e0492bc"
}