Borderzone Infarcts and Recurrent Cerebrovascular Events in Symptomatic Intracranial Arterial Stenosis: A Systematic Review and Meta-Analysis

Saurav Das; Liqi Shu; Rebecca J. Morgan; Asghar Shah; Fayez H. Fayad; Eric D. Goldstein; Dalia Chahien; Benton Maglinger; Satish Kumar Bokka; Cory Owens; Mehdi Abbasi; Alexandra Kvernland; James E. Siegler; Brian Mac Grory; Thanh N. Nguyen; Karen Furie; Pooja Khatri; Eva Mistry; Shyam Prabhakaran; David S. Liebeskind; Jose G. Romano; Adam de Havenon; Lina Palaiodimou; Georgios Tsivgoulis; Shadi Yaghi

doi:10.5853/jos.2023.00185

Journal of Stroke (May 2023)

Borderzone Infarcts and Recurrent Cerebrovascular Events in Symptomatic Intracranial Arterial Stenosis: A Systematic Review and Meta-Analysis

Saurav Das,
Liqi Shu,
Rebecca J. Morgan,
Asghar Shah,
Fayez H. Fayad,
Eric D. Goldstein,
Dalia Chahien,
Benton Maglinger,
Satish Kumar Bokka,
Cory Owens,
Mehdi Abbasi,
Alexandra Kvernland,
James E. Siegler,
Brian Mac Grory,
Thanh N. Nguyen,
Karen Furie,
Pooja Khatri,
Eva Mistry,
Shyam Prabhakaran,
David S. Liebeskind,
Jose G. Romano,
Adam de Havenon,
Lina Palaiodimou,
Georgios Tsivgoulis,
Shadi Yaghi

Affiliations

Saurav Das: Department of Neurology, University of Kentucky, Louisville, KY, USA
Liqi Shu: Department of Neurology, Brown University, Providence, RI, USA
Rebecca J. Morgan: University of Kentucky Medical Center Library, Louisville, KY, USA
Asghar Shah: Department of Neurology, Brown University, Providence, RI, USA
Fayez H. Fayad: Department of Neurology, Brown University, Providence, RI, USA
Eric D. Goldstein: Department of Neurology, Brown University, Providence, RI, USA
Dalia Chahien: Royal College of Surgeons, Dublin, Ireland
Benton Maglinger: Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
Satish Kumar Bokka: Department of Neurology, West Virginia University, Morgantown, WV, USA
Cory Owens: Department of Neurology, University of Kentucky, Louisville, KY, USA
Mehdi Abbasi: Department of Neurology, Yale University, New Haven, CT, USA
Alexandra Kvernland: Department of Neurology, NYU Langone health, New York, NY, USA
James E. Siegler: Department of Neurology, Cooper University Hospital, Camden, NJ, USA
Brian Mac Grory: Department of Neurology, Duke University, Durham, NC, USA
Thanh N. Nguyen: Department of Neurology, Boston University Medical Center, Boston, MA, USA
Karen Furie: Department of Neurology, Brown University, Providence, RI, USA
Pooja Khatri: Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
Eva Mistry: Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
Shyam Prabhakaran: Department of Neurology, University of Chicago, Chicago, IL, USA
David S. Liebeskind: Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
Jose G. Romano: Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
Adam de Havenon: Department of Neurology, Yale University, New Haven, CT, USA
Lina Palaiodimou: Second Department of Neurology, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
Georgios Tsivgoulis: Second Department of Neurology, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
Shadi Yaghi: Department of Neurology, Brown University, Providence, RI, USA

DOI: https://doi.org/10.5853/jos.2023.00185
Journal volume & issue: Vol. 25, no. 2
pp. 223 – 232

Abstract

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Background and Purpose Intracranial arterial stenosis (ICAS)-related stroke occurs due to three primary mechanisms with distinct infarct patterns: (1) borderzone infarcts (BZI) due to impaired distal perfusion, (2) territorial infarcts due to distal plaque/thrombus embolization, and (3) plaque progression occluding perforators. The objective of the systematic review is to determine whether BZI secondary to ICAS is associated with a higher risk of recurrent stroke or neurological deterioration. Methods As part of this registered systematic review (CRD42021265230), a comprehensive search was performed to identify relevant papers and conference abstracts (with ≥20 patients) reporting initial infarct patterns and recurrence rates in patients with symptomatic ICAS. Subgroup analyses were performed for studies including any BZI versus isolated BZI and those excluding posterior circulation stroke. The study outcome included neurological deterioration or recurrent stroke during follow-up. For all outcome events, corresponding risk ratios (RRs) and 95% confidence intervals (95% CI) were calculated. Results A literature search yielded 4,478 records with 32 selected during the title/abstract triage for full text; 11 met inclusion criteria and 8 studies were included in the analysis (n=1,219 patients; 341 with BZI). The meta-analysis demonstrated that the RR of outcome in the BZI group compared to the no BZI group was 2.10 (95% CI 1.52–2.90). Limiting the analysis to studies including any BZI, the RR was 2.10 (95% CI 1.38–3.18). For isolated BZI, RR was 2.59 (95% CI 1.24–5.41). RR was 2.96 (95% CI 1.71–5.12) for studies only including anterior circulation stroke patients. Conclusion This systematic review and meta-analysis suggests that the presence of BZI secondary to ICAS may be an imaging biomarker that predicts neurological deterioration and/or stroke recurrence.

Published in Journal of Stroke

ISSN: 2287-6391 (Print); 2287-6405 (Online)
Publisher: Korean Stroke Society
Country of publisher: Korea, Republic of
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: http://www.j-stroke.org

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