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Associations between Lesion Locations and Stroke Recurrence in Survivors of First-ever Ischemic Stroke: A Prospective Cohort Study

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Summary

Several studies have indicated that stroke survivors with multiple lesions or with larger lesion volumes have a higher risk of stroke recurrence. However, the relationship between lesion locations and stroke recurrence is unclear. We conducted a prospective cohort study of first-ever ischemic stroke survivors who were consecutively enrolled from January 2010 to December 2015. Stroke recurrence was assessed every 3 months after post-discharge via telephone interviews by trained interviewers. Lesion locations were obtained from hospital-based MRI or CT scans and classified using two classification systems that were based on cerebral hemisphere or vascular territory and brain anatomical structures. Flexible parametric survival models using the proportional hazards scale (PH model) were used to analyze the time-to-event data. Among 633 survivors, 63.51% (n=402) had anterior circulation ischemia (ACI), and more than half of all ACIs occurred in the subcortex. After a median follow-up of 2.5 years, 117 (18.48%) survivors developed a recurrent stroke. The results of the multivariate PH model showed that survivors with non-brain lesions were at higher risk of recurrence than those with right-side lesions (HR, 2.79; 95%CI, 1.53, 5.08; P=0.001). There was no increase in risk among survivors with left-side lesions (HR, 0.97; 95%CI, 0.53, 1.75; P=0.914) or both-side lesions (HR, 1.24; 95%CI, 0.75, 2.07; P=0.401) compared to those with right-side lesions. Additionally, there were no associations between stroke recurrence and lesion locations that were classified based on vascular territory and brain anatomical structures. It was concluded that first-ever ischemic stroke survivors with non-brain lesion had higher recurrence risk than those with right-side lesion, although no significant associations were found when the lesion locations were classified by vascular territory and brain anatomical structures.

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Author notes

  1. Both authors contributed equally to this work.

Authors and Affiliations

  1. Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610044, China

    Pei-jing Yan, Li-sha Hou, Mi-er Li, Feng-yu Zhan, Meng-dong Ran, Lu Zhang & Cai-rong Zhu

  2. National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610044, China

    Li-sha Hou

  3. The First Clinical College of Lanzhou University, Lanzhou, 730000, China

    Zhen-xing Lu

  4. Department of Medical Record, West China Second University School, Chengdu, 610044, China

    Ji-jie Li

  5. Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610044, China

    Rong Yang & Mu-ke Zhou

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  1. Pei-jing Yan
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Correspondence to Mu-ke Zhou or Cai-rong Zhu.

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Additional information

This study was funded by the National Natural Science Foundation of China (No. 81673273 and No. 30600511).

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Yan, Pj., Hou, Ls., Li, Me. et al. Associations between Lesion Locations and Stroke Recurrence in Survivors of First-ever Ischemic Stroke: A Prospective Cohort Study. CURR MED SCI 40, 708–718 (2020). https://doi.org/10.1007/s11596-020-2240-y

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