• Adam de Havenon, Pooja Khatri, Shyam Prabhakaran, Sharon D Yeatts, Cecilia Peterson, Daniel Sacchetti, Matthew Alexander, Shawna Cutting, Brian Mac Grory, Karen Furie, David S Liebeskind, and Shadi Yaghi.
• Department of Neurology, University of Utah, Salt Lake City, UT.
• J Neuroimaging. 2020 Jul 1; 30 (4): 468-470.

Background And PurposeIn patients with symptomatic vertebrobasilar intracranial atherosclerotic disease (ICAD), impaired distal flow predicts recurrent stroke, but limited data exist on the association between perfusion status and recurrent stroke in anterior circulation ICAD.MethodsThis is a retrospective study of patients hospitalized for symptomatic ICAD with 50-99% stenosis of the intracranial carotid or middle cerebral artery. The primary outcome is recurrent symptomatic ischemic stroke in the territory of the artery with ≥50% stenosis within 90 days. The primary predictor is distal hypoperfusion on magnetic resonance (MR) or computed tomography (CT) perfusion, defined as a ≥15 mL volume of territory of the symptomatic artery with Tmax >6 seconds.ResultsFifty patients met inclusion criteria, including 15 (30%) with recurrent stroke and 15 (30%) with distal hypoperfusion. Distal hypoperfusion was present in 10 of 15 (66.7%) with recurrent stroke versus 5 of 35 (14.3%) without recurrent stroke (P < .001). The hazard ratio for recurrent stroke in patients with distal hypoperfusion was 6.80 (95% confidence interval [CI] 2.31-20.0).ConclusionDistal hypoperfusion in acutely symptomatic ICAD with 50-99% stenosis is associated with stroke recurrence. Distal hypoperfusion could be used to enrich future trials of secondary stroke prevention in ICAD patients.© 2020 American Society of Neuroimaging.

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