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KMID : 1142120230250020223
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Journal of Stroke
2023 Volume.25 No. 2 p.223 ~ p.232
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Borderzone Infarcts and Recurrent Cerebrovascular Events in Symptomatic Intracranial Arterial Stenosis: A Systematic Review and Meta-Analysis
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Saurav Das
Liqi Shu
Rebecca J. Morgan
Asghar Shah
Fayez H. Fayad
Eric D. Goldstein
Dalia Chahien
Benton Maglinger
Satish Kumar Bokka
Cory Owens
Mehdi Abbasi
Alexandra Kvernland
James E. Siegler
Brian Mac Grory
Thanh N. Nguyen
Karen Furie
Pooja Khatri
Shyam Prabhakaran
David S. Liebeskind
Jose G. Romano
Adam de Havenon
Lina Palaiodimou
Georgios Tsivgoulis
Shadi Yaghi
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Abstract
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Background and Purpose Intracranial arterial stenosis (ICAS)-related stroke occurs due to three primary mechanisms with distinct infarct patterns: (1) borderzone infarcts (BZI) due to impaired distal perfusion, (2) territorial infarcts due to distal plaque/thrombus embolization, and (3) plaque progression occluding perforators. The objective of the systematic review is to determine whether BZI secondary to ICAS is associated with a higher risk of recurrent stroke or neurological deterioration.
Methods As part of this registered systematic review (CRD42021265230), a comprehensive search was performed to identify relevant papers and conference abstracts (with ≥20 patients) reporting initial infarct patterns and recurrence rates in patients with symptomatic ICAS. Subgroup analyses were performed for studies including any BZI versus isolated BZI and those excluding posterior circulation stroke. The study outcome included neurological deterioration or recurrent stroke during follow-up. For all outcome events, corresponding risk ratios (RRs) and 95% confidence intervals (95% CI) were calculated.
Results A literature search yielded 4,478 records with 32 selected during the title/abstract triage for full text; 11 met inclusion criteria and 8 studies were included in the analysis (n=1,219 patients; 341 with BZI). The meta-analysis demonstrated that the RR of outcome in the BZI group compared to the no BZI group was 2.10 (95% CI 1.52?2.90). Limiting the analysis to studies including any BZI, the RR was 2.10 (95% CI 1.38?3.18). For isolated BZI, RR was 2.59 (95% CI 1.24?5.41). RR was 2.96 (95% CI 1.71?5.12) for studies only including anterior circulation stroke patients.
Conclusion This systematic review and meta-analysis suggests that the presence of BZI secondary to ICAS may be an imaging biomarker that predicts neurological deterioration and/or stroke recurrence.
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KEYWORD
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Borderzone Infarct, Stroke, Recurrence, Intracranial arterial diseases, Intracranial atherosclerosis
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FullTexts / Linksout information
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Listed journal information
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