Does all single infarction have lower risk of stroke recurrence than multiple infarctions in minor stroke?

Guangyao Wang, Jing Jing, Yuesong Pan, Xia Meng, Xingquan Zhao, Liping Liu, Hao Li, David Wang, Yongjun Wang, Yilong Wang, CHANCE Investigatores, Yongjun Wang, S Claiborne Johnston, Yilong Wang, Xingquan Zhao, Zhimin Wang, Haiqin Xia, Guiru Zhang, Xudong Ren, Chunling Ji, Guohua Zhang, Jianhua Li, Bohua Lu, Liping Wang, Shutao Feng, Dali Wang, Weiguo Tang, Juntao Li, Hongtian Zhang, Guanglai Li, Baojun Wang, Yuhua Chen, Ying Lian, Bin Liu, Junfang Teng, Rubo Sui, Lejun Li, Zhiling Yuan, Dawei Zang, Zuneng Lu, Li Sun, Dong Wang, Liying Hou, Dongcai Yuan, Yongliang Cao, Hui Li, Xiuge Tan, Huicong Wang, Haisong Du, Mingyi Liu, Suping Wang, Qiuwu Liu, Zhong Zhang, Qifu Cui, Runqing Wang, Jialin Zhao, Jiewen Zhang, Jianping Zhao, Qi Bi, Xiyou Qi, Junyan Liu, Changxin Li, Ling Li, Xiaoping Pan, Junling Zhang, Derang Jiao, Zhao Han, Dawei Qian, Jin Xiao, Yan Xing, Huishan Du, Guang Huang, Yongqiang Cui, Yan Li, Lianyuan Feng, Lianbo Gao, Bo Xiao, Yibin Cao, Yiping Wu, Jinfeng Liu, Zhiming Zhang, Zhengxie Dong, Limin Wang, Li He, Xinchen Wang, Xueying Guo, Ming Wang, Xiaosha Wang, Jiandong Jiang, Renliang Zhao, Shengnian Zhou, Hao Hu, Maolin He, Fengchun Yu, Quping Ouyang, Jingbo Zhang, Anding Xu, Xiaokun Qi, Lei Wang, Fuming Shi, Fuqiang Guo, Jianfeng Wang, Fengli Zhao, Ronghua Dou, Dongning Wei, Qingwei Meng, Yilu Xia, Shimin Wang, Zhangcang Xue, Yuming Xu, Liping Ma, Chun Wang, Jiang Wu, Yifeng Du, Yinzhou Wang, Lijun Xiao, Fucong Song, Wenli Hu, Zhigang Chen, Qingrui Liu, Jiemin Zhang, Mei Chen, Xiaodong Yuan, Zhihui Liu, Guozhong Li, Xiaohong Li, Tingchen Tian, Guangyao Wang, Jing Jing, Yuesong Pan, Xia Meng, Xingquan Zhao, Liping Liu, Hao Li, David Wang, Yongjun Wang, Yilong Wang, CHANCE Investigatores, Yongjun Wang, S Claiborne Johnston, Yilong Wang, Xingquan Zhao, Zhimin Wang, Haiqin Xia, Guiru Zhang, Xudong Ren, Chunling Ji, Guohua Zhang, Jianhua Li, Bohua Lu, Liping Wang, Shutao Feng, Dali Wang, Weiguo Tang, Juntao Li, Hongtian Zhang, Guanglai Li, Baojun Wang, Yuhua Chen, Ying Lian, Bin Liu, Junfang Teng, Rubo Sui, Lejun Li, Zhiling Yuan, Dawei Zang, Zuneng Lu, Li Sun, Dong Wang, Liying Hou, Dongcai Yuan, Yongliang Cao, Hui Li, Xiuge Tan, Huicong Wang, Haisong Du, Mingyi Liu, Suping Wang, Qiuwu Liu, Zhong Zhang, Qifu Cui, Runqing Wang, Jialin Zhao, Jiewen Zhang, Jianping Zhao, Qi Bi, Xiyou Qi, Junyan Liu, Changxin Li, Ling Li, Xiaoping Pan, Junling Zhang, Derang Jiao, Zhao Han, Dawei Qian, Jin Xiao, Yan Xing, Huishan Du, Guang Huang, Yongqiang Cui, Yan Li, Lianyuan Feng, Lianbo Gao, Bo Xiao, Yibin Cao, Yiping Wu, Jinfeng Liu, Zhiming Zhang, Zhengxie Dong, Limin Wang, Li He, Xinchen Wang, Xueying Guo, Ming Wang, Xiaosha Wang, Jiandong Jiang, Renliang Zhao, Shengnian Zhou, Hao Hu, Maolin He, Fengchun Yu, Quping Ouyang, Jingbo Zhang, Anding Xu, Xiaokun Qi, Lei Wang, Fuming Shi, Fuqiang Guo, Jianfeng Wang, Fengli Zhao, Ronghua Dou, Dongning Wei, Qingwei Meng, Yilu Xia, Shimin Wang, Zhangcang Xue, Yuming Xu, Liping Ma, Chun Wang, Jiang Wu, Yifeng Du, Yinzhou Wang, Lijun Xiao, Fucong Song, Wenli Hu, Zhigang Chen, Qingrui Liu, Jiemin Zhang, Mei Chen, Xiaodong Yuan, Zhihui Liu, Guozhong Li, Xiaohong Li, Tingchen Tian

Abstract

Background: Single acute infarction (SAI) usually had lower risk of stroke recurrence than multiple acute infarctions (MAIs) in minor stroke. To evaluate whether all SAI had lower risk of stroke recurrence than MAIs in minor stroke.

Methods: We derived data from the imaging subgroup of the Clopidogrel in High-risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial. Minor stroke were categorized into SAI and MAIs by infarction numbers in diffusion weighted imaging. SAI were classified as lacunar infarction and non-lacunar infarction. The outcome was stroke recurrence within one-year follow-up. We assessed the associations between infarction patterns and stroke recurrence using multivariable Cox regression models.

Results: Overall, 834 patients with minor stroke were included in this subgroup, 553 SAI (381 lacunar infarction, 172 non-lacunar infarction) and 281 MAIs. The rate of stroke recurrence was 7.6%, 15.1% and 15.3% in lacunar infarction of SAI, non-lacunar infarction of SAI and MAIs at one year, respectively. Compared with MAIs, lacunar infarction of SAI had lower risk of stroke recurrence (hazard ratio [HR] 0.41, 95% confidence interval [CI] 0.21-0.80, P = 0.009), but not in non-lacunar infarction of SAI (HR 1.01, 95% CI 0.60-1.69, P = 0.98).

Conclusions: Lacunar infarction of SAI have lower risk of stroke recurrence than MAIs, while non-lacunar infarction of SAI might have similar risk as MAIs. Except for the number of infarctions, size and location should also be considered to stratify risk of stroke recurrence in minor stroke.

Trial registration: http://www.clinicaltrials.gov Unique identifier: NCT00979589 . Date of registration: September 2009.

Keywords: Infarction patterns; Minor stroke; Prognosis.

Conflict of interest statement

Ethics approval and consent to participate

Name of the ethics committee is IRB of Beijing Tiantan Hospital, Capital Medical University. Ethics approval number of this study is ky2009–002. The trial was approved by the Ethics Committee of Beijing Tiantan Hospital and all the participating hospitals. Written informed consent was obtained from all participants or their legal proxies.

Consent for publication

In the patient informed consent were stated that all collected data will be analyzed and prepared for publications. All patients gave signed informed consent prior to inclusion in the study.

Competing interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Infarction patterns of single acute infarction and multiple acute infarctions. Multiple acute infarctions. a Unilateral anterior circulation; b Posterior circulation; c Multiple circulations; d Border-zone territories. Single acute infarction. e Subcortical lesion with diameter ≤ 15 mm; f Subcortical lesion with diameter > 15 mm; g Corticosubcortical lesion; h Cortical lesion
Fig. 2
Fig. 2
Stroke recurrence of single acute infarction (lacunar and non-lacunar infarction) and multiple acute infarction

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