Clinicoradiological features of recurrent ischemic stroke: healthcare for poststroke patients

Takehisa Hirayama, Yoshikazu Nakamura, Yasuhiro Yoshii, Ken Ikeda

Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan

Objective: Little is known about recurrent risk profile of brain infarct (BI) in Japan. The study aimed to clarify clinicoradiological features of recurrent BI patients.

Methods: 374 consecutive BI patients (231 men and 143 women) were admitted to our ­department between 2007 and 2008. Recurrent BI was defined as a prior history of BI. ­Cardiovascular disease (CVD) risk profile, stroke mechanism subtypes and Bamford subtypes were compared between the first BI and the recurrent BI group. CVD risk factors, stroke subtypes of the first BI and preventative medication were analyzed in recurrent BI patients.

Results: Recurrent BI existed in 72 patients (40 men and 32 women). Age of the recurrent BI group was significantly older than the first BI group (P < 0.01). In comparison to the first BI group, the recurrent BI group had a high frequency of hypertension (P < 0.01) and CVD comorbidity (P < 0.05). Recurrent rates were increased significantly in cardioembolic patients as compared to the first BI patients (P < 0.05). Bamford BI subtypes did not differ between both groups. Mean recurrent interval (SD) was 3.1 (2.3) years. Approximately half the patients experienced recurrent BI less than 2 years after the first BI. Antiplatelet agents were used in 33 patients and warfarin was used in 12 patients as preventative medication. The remaining 27 patients had no prevention therapy by self-cessation. Nine warfarin users were controlled poorly. There were no significant correlations between the first and recurrent Bamford subtypes in recurrent BI patients.

Conclusions: The present study indicated that the recurrent frequency of BI was 19.3%. Causative profile of recurrent BI suggested elderly age (≥65 years), hypertension, prior history of CVD, cardioembolism, 2 years poststroke, insufficient treatment of warfarin and self-cessation of preventative medication. Thus, physicians should pay more attention to these aspects for prophylaxis of recurrent BI in poststroke patients.

Keywords: brain infarct, recurrence, cardiovascular disease risk profile, secondary prevention