Predictors of ischemic stroke recurrence in patients with symptomatic ICAS and contralateral high-grade stenosis

Objective: This study aims to identify predictive factors for the recurrence risk of ischemic stroke in patients with symptomatic ICAS and contralateral high-grade stenosis (sICAS-CHS). Methods: We consecutively enrolled patients diagnosed with sICAS-CHS, which characterized by severe symptomatic intracranial artery stenosis (sICAS) alongside severe contralateral asymptomatic internal carotid artery or middle cerebral artery stenosis, confirmed by CT angiography (CTA). Over a one-year period, these patients were followed up to assess the recurrence risk of ischemic stroke. Binary logistic regression analysis was utilized to investigate the independent predictors of ipsilateral ischemic stroke recurrence within the territory of the symptomatic ICAS. Results: The study included 80 patients with sICAS-CHS, comprising 56 males (70 %) with an average age of 69.44 +/- 9.97 years. Over the one-year follow-up period, 16 patients (20 %) experienced recurrent ischemic strokes. Binary logistic regression analysis revealed that presence of watershed infarction (OR=6.002, p = 0.019), hyperhomocysteinemia (OR=4.469, p = 0.039), medication adherence (OR=0.207, p = 0.034), and endovascular therapy (OR=0.084, p = 0.029) were independent predictors of ischemic stroke recurrence in this cohort. Conclusions: Patients with severe sICAS-CHS portended a considerable high recurrence risk of ischemic stroke. It is advisable to prioritize these individuals for endovascular therapy, particularly those who have suffered watershed infarctions.