Citations 2
Abstract WP112: Predictors of 90-Day Recurrent Stroke in Patients with High-Grade Intracranial Atherosclerotic Stenosis: A subgroup analysis from the BIORISK-ICAS Study
Stretz, Christoph, Lewis, Skylar, Chahien, Dalia, Alam, Shaista , Halabi, Tarek El, Guerrero, Chris, Walsh, Hadley A., Frontera, Jennifer, baker, rich, Nguyen, Thanh, Tunguturi, Ajay, Khan, Muhib, Klaas, James P. , Liebeskind, D, Morsi, Rami, Helenius, Johanna, Khatri, Pooja, Freitas, Joao, Aziz, Yasmin, Rothstein, Aaron, Shu, Liqi , Reda, Mahasen, Tountopoulou, Argyro , Khasawneh, Mohammad W , Klein, Piers, Havenon, Adam de, Almiri, William , Prabhakaran, S, AlMajali, Mohammad, Zaidat, Osama, Qdais, Ahmad Abu, McCullough-Hicks, Margy, Elangovan, Cheran, Sousa, João André, Romoli, Michele, Henninger, Nils, Marto, Joao Pedro, Agarwal, Ayush, Kasab, Sami Al, Yaddanapudi, Sridhara , Krishnaiah, Balaji , Sousa, Diana Aguiar de, Yaghi, Shadi, Henninger, Nils , Sousa, Diana Aguiar de , Henninger, Nils , Aguiar de Sousa, Diana , Khan, Fahad , Stretz, Christoph , Alam, Shaista, Halabi, Tarek El , Sloane, Kelly L , Heldner, Mirjam R. , Antonenko, Kateryna , Baker, Richard, Khan, Muhib , Marrone, Nicole L. , Siegler, James E. , Morsi, Rami Z. , Aziz, Yasmin , Rothstein, Aaron , Reda, Mahasen , Prabhakaran, Shyam , McCullough‐Hicks, Margy , Elangovan, Cheran , Romoli, Michele , Marto, João Pedro , Kasab, Sami Al
Stroke | January 29, 2026 | Volume: 57 | Issue: Suppl_1 | Pages: No page available
Background: High-grade intracranial atherosclerosis (ICAS) is associated with an elevated risk of recurrent ischemic stroke, particularly in patients with severe stenosis (70–99%). Identifying predictors of early recurrence can inform risk stratification and guide treatment strategies. Methods: The Biomarkers and Recurrence Risk in Symptomatic Intracranial Arterial Stenosis (BIORISK-ICAS) study is a multicenter, international, retrospective cohort analysis pooling data from 35 comprehensive stroke centers. We included hospitalized adult patients with symptomatic ICAS, defined as 50–99% stenosis of an intracranial artery (intracranial vertebral, basilar, distal ICA, or M1 MCA), confirmed by vascular imaging and associated with a qualifying ischemic event. Patients with only high-grade stenosis (70-99%) were included in this analysis. The primary outcome was to determine predictors of recurrent ischemic stroke in the territory of the symptomatic artery within 90 days of the index event. Baseline demographic, clinical, and imaging characteristics were recorded. Multivariable Cox proportional hazards regression with stepwise selection (p < 0.1) was used to identify independent predictors of recurrence; model discrimination was assessed using Harrell’s C-statistics. Results: Among 2,050 patients, 1,476 had high-grade (70-99%) symptomatic ICAS. The mean age was 67 ± 12.5 years, and 767 (55%) were male. Most patients were non-Hispanic (90.1%), taking dual antiplatelet therapy (77.8%), and statins (94.5%). Recurrent stroke occurred in 160 patients (10.8%) within 90 days. In multivariable Cox model, independent predictors of recurrence included atrial fibrillation (HR 2.05; 95% CI, 1.26–3.33; p = 0.004), hyperlipidemia (HR 1.57; 95% CI, 1.10–2.24; p = 0.014), diabetes mellitus (HR 1.36; 95% CI, 0.98–1.88; p = 0.064), and home use of dual antiplatelet therapy (HR 1.60; 95% CI, 1.01–2.54; p = 0.043)(Harrell’s C-statistic=0.62). In patients who underwent perfusion(n=402), mistmatch >10seconds were associated with increased recurrence (HR 1.80; 95% CI 0.95-3.38, p=0.07) and atrial fibrillation (HR 2.06: 95% CI 0.03-4.60, p=0.78) though did not reach statistical significance. Conclusion: In this population, diabetes, hyperlipidemia, atrial fibrillation, and prior use of dual antiplatelet therapy were associated with increased risk of 90-day recurrent ischemic stroke. Perfusion imaging may help identify high-risk patients who could benefit from intensified secondary prevention.
Impaired Perfusion and Early Ischemic Stroke Recurrence in Symptomatic Intracranial Atherosclerosis: BIORISK ICAS Study
Yaghi, Shadi , Khan, Farhan , Lewis, Skylar, Stipanovich, Ava, Choi, Richard , Baker, Richard, Kasab, Sami Al , Qdais, Ahmad Abu, Yaddanapudi, Sridhara , Sultana, Sabiha , Khan, Muhib , Malik, Maarij , Klaas, James P. , Bakradze, Ekaterina , Ressler, Hadley W. , McCullough‐Hicks, Margy , Cooper, Dawson C , Pillai, Abhiram Parameswaran, Hariharan, Praveen , Alam, Shaista , Mayer, Morgan, Kugler, Irina, Almiri, William , Secchi, Thaís , Mantovani, Gabriel Paulo , Rothstein, Aaron , Krishnaiah, Balaji , Alfred, Linda Sherine , Vishnu, Venugopalan Y. , Chandu, Meena, Agarwal, Ayush , Marrone, Nicola , Vozzi, Stefano, Ghannam, Malik , Elshikh, Mohamed , Hou, Yan , Peshwe, Krithika Umesh, Tunguturi, Ajay, Frontera, Jennifer , Zaidat, Osama O. , Barakat, Benan , Khan, Niha, Sen, Shayak, Coelho, Mariana Lima , Sousa, João André , Sousa, Diana Aguiar de , Soares, Mafalda , Rodrigues, Amanda Cyntia Lima Fonseca , Jhaveri, Aditya , Bhati, S., Vassilopoulou, Sofia , Tountopoulou, Argyro , Muddasani, Varsha , Henninger, Nils , Tran, Hieu , Helenius, Johanna, Khasawneh, Mohammad W , Vellimana, Ananth K. , Apfel, Ryan , Molaie, Amir , Mannino, Marina , Terruso, Valeria, Halabi, Tarek El , Reda, Mahasen , Tamer, Christel, Shu, Liqi , Khatri, Pooja , Furie, Karen L. , Liebeskind, David S. , Al Kasab, Sami , Klaas, James P , Aemaz Ur Rehman, Muhammad , Leon Guerrero, Christopher R , Ressler, Hadley Walsh , Saleh Velez, Faddi , Owens, Cameron , McCullough-Hicks, Margy , Cooper, Dawson , Parameswaran Pillai, Abhiram , Hariharan, Praveen , Heldner, Mirjam R , Antonenko, Kateryna , Almiri, William , Martins, Sheila , Mantovani, Gabriel , Rothstein, Aaron , Sloane, Kelly L , Krishnaiah, Balaji , Elangovan, Cheran , Vishnu, Venugopalan Y , Chandu, Meena , Agarwal, Ayush , Romoli, Michele , Ghannam, Malik , Elshikh, Mohamed , Dibas, Mahmoud , Hou, Yan , Tunguturi, Ajay , Marto, João Pedro , Duarte Armindo, Rui , Frontera, Jennifer , Kuohn, Lindsey , Almajali, Mohammad , Zaidat, Osama O , Barakat, Benan , Simpkins, Alexis N , Coelho, Mariana , Sargento-Freitas, Joao , Sousa, Joao Andre , Aguiar de Sousa, Diana , Soares, Mafalda , Cyntia Lima Fonseca Rodrigues, Amanda , Jhaveri, Aditya , Morsi, Rami Z , Siegler, James E , Aziz, Yasmin , Harker, Pablo , Vassilopoulou, Sofia , Tountopoulou, Argyro , de Havenon, Adam H , Henninger, Nils , Tran, Hieu , Khasawneh, Mohammad , Vellimana, Ananth , Apfel, Ryan , Molaie, Amir , Mannino, Marina , Terruso, Valeria , Klein, Piers , Shu, Liqi , Khatri, Pooja , Furie, Karen L , Nguyen, Thanh N , Liebeskind, David S. , Prabhakaran, Shyam , Yaghi, Shadi , Choi, Richard , Khan, Farhan , Sultana, Sabiha, Rehman, Muhammad Aemaz Ur , Velez, Faddi G. Saleh , Pinto, Camila Bonin , Alam, Shaista, Mayer, Morgan, Heldner, Mirjam R. , Kugler, Irina, Elangovan, Cheran , Dibas, Mahmoud , Marto, João Pedro , Kuohn, Lindsey , Almajali, Mohammad , Khan, Niha, Simpkins, Alexis N. , Sen, Shayak, Morsi, Rami Z. , Siegler, James E. , Aziz, Yasmin , Harker, Pablo , Bhati, Sonia, Havenon, Adam de , Tamer, Christel, Klein, Piers , Nguyen, Thanh N. , Prabhakaran, Shyam
Stroke | October 23, 2025 | Volume: 57 | Issue: 1 | Pages: 96-106
BACKGROUND: Intracranial atherosclerosis (ICAS) is associated with an increased risk of early recurrent ischemic stroke. We evaluated whether biomarkers of impaired distal perfusion—specifically, anterior circulation borderzone infarct, and hypoperfusion mismatch volume—were associated with recurrent ischemic stroke within 90 days. METHODS: The BIORISK ICAS (Biomarkers and Recurrence Risk in Symptomatic Intracranial Atherosclerosis) is a multicenter retrospective international study (35 sites) that included hospitalized patients with symptomatic ICAS (50%–99% luminal stenosis of the intracranial vertebral, basilar, distal internal carotid, or proximal middle cerebral artery) from January 2019 to June 2024. The primary outcome was recurrent ischemic stroke in the territory of the symptomatic artery within 90 days. In the primary analysis, the exposure was an acute anterior circulation borderzone infarct. In secondary analysis of the subset with presentation within 72 hours of last known normal and perfusion imaging completed, the exposure of interest was prespecified as hypoperfusion mismatch volume at T max (time to maximum) threshold of 6 seconds, dichotomized at the Youden index. We performed multivariable Cox regression to test associations between exposure variables and the outcome, adjusting for clinically relevant variables and those associated with the outcome ( P <0.1). RESULTS: Of 2050 patients with symptomatic ICAS, 1737 (84.7%) presented within 72 hours of symptom onset, among whom 509 (29.3%) underwent perfusion imaging. The primary analysis included 1891 patients; 174 (9.2%) patients had recurrent ischemic stroke in the symptomatic arterial territory. In adjusted Cox regression models, there was an association between anterior circulation borderzone infarct and recurrent ischemic stroke at 90 days (adjusted hazard ratio, 1.40 [95% CI, 1.02–1.93]). In the perfusion imaging analysis, hypoperfusion mismatch of ≥10 mL was associated with recurrent ischemic stroke (adjusted hazard ratio, 1.83 [95% CI, 1.03–3.28]). CONCLUSIONS: Biomarkers of impaired distal perfusion, anterior circulation borderzone infarct, and hypoperfusion mismatch were associated with increased risk of recurrent ischemic stroke. These findings support the use of perfusion imaging in ICAS as well as future trials investigating early reperfusion in high-risk patients with ICAS.