In a recent issue of Circulation, it was revealed that among patients who have suffered a single stroke, severe stenosis – or the narrowing – of the arteries in the head represents a major risk factor for the development of a subsequent stroke. Also, patients with recent symptoms were at high risk, and women faced a greater risk of subsequent stroke than men.
The work, by researchers at the University of Pennsylvania School of Medicine, along with colleagues at other institutions, lays the foundation for further studies into effective therapies to prevent secondary strokes.
The researchers' findings are part of a larger, multi-site clinical investigation that found aspirin to be the preferred medical therapy for preventing a secondary stroke.
The Penn study – which has now identified the patient-population that is most at-risk for a secondary stroke – sets the stage for more studies to test alternative treatments. "We need to be more aggressive in the treatment of these high-risk patients," stated Scott Kasner, M.D., lead author of the study and director of Penn's Stroke Center
"Stenting and angioplasty in the brain are promising treatments for intracranial stenosis, and this study identified the target group for a new trial comparing these treatments with traditional medical therapy," he said.
Using data from the trial, Kasner's study analyzed five probable clinical factors that contribute to a subsequent stroke in the territory of the initial event – including type of qualifying event (stroke or TIA); location of vessel; percent of stenosis; treatment with antithrombotic medications at the time of the preliminary stroke; and time from the qualifying event to enrollment in the study.
After adjusting for age, gender and race, the researchers found that patients with severe stenosis (at or greater than 70 percent of the affected vessel's diameter), recent symptoms and female gender were associated with a significantly higher subsequent risk of stroke in the territory of a symptomatic intracranial stenotic artery than other groups.
As such, the doctor noted that "our observations suggest that potential intervention should be considered very soon after clinical presentation, unless early intervention also increases the short-term risk."
This study was funded by a research grant from the U.S. Public Health Service, NINDS.
For more information on the evaluation of intracranial stenosis, call Penn's Stroke Center at 215-662-4904.