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Open Access Highly Accessed Research article

Final 2 year results of the vascular imaging of acute stroke for identifying predictors of clinical outcome and recurrent ischemic eveNts (VISION) study

Shelagh B Coutts1*, Michael D Hill2, Misha Eliasziw3, Karyn Fischer4, Andrew M Demchuk5 and the VISION study group

Author Affiliations

1 Room C1261, Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, University of Calgary, 1403 29th St NW, Calgary, AB, T2N 2T9, Canada

2 Calgary Stroke Program, Department of Clinical Neurosciences, Radiology, Community Health Sciences, and Medicine, University of Calgary, 1403 29th St NW, Calgary, AB, T2N 2T9, Canada

3 Department of Community Health Sciences, University of Calgary, 1403 29th St NW, Calgary, AB, T2N 2T9, Canada

4 Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, 1403 29th St NW, Calgary, AB, T2N 2T9, Canada

5 Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, University of Calgary, 1403 29th St NW, Calgary, AB, T2N 2T9, Canada

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BMC Cardiovascular Disorders 2011, 11:18  doi:10.1186/1471-2261-11-18

Published: 23 April 2011

Abstract

Among patients with ischemic stroke, little attention has been paid to differentiation between stroke progression and recurrence. We assessed the role of MR imaging in predicting stroke progression, recurrent stroke, and death within 2 years of symptom onset.

Methods

Ischemic stroke or TIA patients were prospectively enrolled. They were examined within 12 hours and had a stroke MR completed within 24 hours of symptom onset. Patients were closely followed neurologically and examined if there was any deterioration in neurological status. Relationships between baseline clinical and imaging factors and outcomes were assessed. We also examined whether baseline stroke/TIA severity (NIHSS 0-5 versus NIHSS > 5) modified these relationships.

Results

A total of 334 patients were enrolled. The overall rates of progression, 2-year recurrence, and 2-year death were 8.7%, 8.0%, and 6.6%, respectively. Event rates were similar among patients with mild compared to more severe strokes: 8.3% versus 9.5% (p = 0.73) for progression, and 7.3% versus 9.9% (p = 0.59) for recurrence. The effect of baseline glucose > 8 mmol/l was consistent in predicting stroke progression, recurrent stroke and death, regardless of baseline stroke severity. In multivariable analyses, DWI lesion and intracranial occlusion predicted stroke progression only in the minor stroke/TIA group; symptomatic Internal Carotid Artery (ICA) stenosis predicted stroke recurrence only in the minor stroke/TIA group.

Conclusions

In a prospective study with early assessment and imaging we have found that stroke progression is different than stroke recurrence. Different imaging factors predict stroke progression versus stroke recurrence. Baseline hyperglycemia, a potentially modifiable factor, consistently predicted all three outcomes (stroke progression, recurrent stroke or death) regardless of baseline stroke severity.

Keywords:
Magnetic resonance Imaging; Stroke; outcome; recurrent stroke