Associations of intracranial atherosclerotic burden and imaging-based lesion category with ischemic stroke

Abstract Background Intracranial atherosclerotic stroke (ICAS) is strongly associated with single and multiple infarctions. The present study aimed to assess the associations of imaging-based lesion category and intracranial atherosclerosis burden (ICASB) with ischemic stroke (IS), and to determine whether multiple infarctions may be related to increased prevalence of ICASB. Methods In this study, 2864 consecutive cases from 22 Chinese hospitals who had acute cerebral ischemia < 7 days after symptom onset were included. After magnetic resonance angiography, the patients were categorized into three groups, with scores of  7, respectively, according to the degree of IS reflected by ICASB, and also divided into single and multiple infarction groups taking into consideration the number of acute infarction-related lesions. Results Reduced NIHSS score at patient admission and complete circle of Willis were closely associated with single infarction. However, patients with multiple infarctions had higher ICASB compared with the single infarction group, particularly in the ICASB4-7 and > 7 subgroups (P < 0.0002). Patients with multiple infarctions showed prolonged hospital stay (p < 0.0033) and increased brain damage or ischemic stroke (IS) recurrence within 1 year (p < 0.0008). In multivariate analysis, complete circle of Willis (HR = 2.56, 95%CI 1.16–5.66; P = 0.0199) and family history of stroke (HR = 2.07, 95%CI 1.054–4.071; P = 0.034) were independent predictors of multiple infarctions, unlike elevated ICASB (ICASB4-7 group, p = 0.23; ICASB > 7group, p = 0.24) Conclusions Patients with multiple infarctions have significantly elevated ICASB, and show increase brain damage or IS recurrence within 1 year. High ICASB is not an independent predictor of multiple infarctions.