AUTHOR=Sangha Rajbeer S. , Prabhakaran Shyam , Feldmann Edward , Honda Tristan , Nizam Azhar , Cotsonis George A. , Campo-Bustillo Iszet , Romano Jose G. , Liebeskind David S. 

TITLE=Imaging Patterns of Recurrent Infarction in the Mechanisms of Early Recurrence in Intracranial Atherosclerotic Disease (MyRIAD) Study

JOURNAL=Frontiers in Neurology

VOLUME=Volume 11 - 2020

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2020.615094

DOI=10.3389/fneur.2020.615094

ISSN=1664-2295

ABSTRACT=Introduction: While there is much known about recurrent clinical events in patients with intracranial atherosclerotic disease (ICAD), there are limited data on characteristics of recurrent infarcts. 

Methods: The NIH-funded MyRIAD prospective, observational study was designed to identify mechanisms of ischemia and predictors of recurrence in ICAD. Recurrent infarction was assessed on MRI at 6-8 weeks. We reviewed the DWI/ADC and FLAIR sequences in patients with recurrent stroke and characterized the number of infarcts, infarct location, size, and patterns based on whether they were borderzone (BZ), subcortical or perforator (SC/P), cortical or territorial (C/T) and mixed. Temporal characteristics were delineated by ADC/FLAIR correlation. 

Results: Of 89 patients with 6-8 week MRI, 22 (24.7%) had recurrent infarcts in the territory of the symptomatic artery. Recurrent infarcts were evident on DWI in 63.6% and single in 54.5%. The median recurrent infarct volume was 2.0 cm3 compared to median index infarct volumes of 2.5 cm3. A mixed infarct pattern was most common (40.9%), followed by borderzone (22.7%), cortical or territorial (27.3%), while only 9.1% were in a perforator artery distribution. Amongst those with a mixed pattern, 8/9 had a borderzone distribution infarct as part of their mixed infarct pattern. 

Conclusion: These findings provide novel data on the characteristics of early recurrent infarcts in patients with symptomatic ICAD.