Classification of Covert Brain Infarct Subtype and Risk of Death and Vascular Events

Jose Gutierrez, Andrea Gil-Guevara, Srinath Ramaswamy, Janet DeRosa, Marco R. Di Tullio, Ken Cheung, Tatjana Rundek, Ralph L. Sacco, Clinton B. Wright, Mitchell S.V. Elkind

Research output: Contribution to journalArticle

Abstract

Background and Purpose- To test the hypothesis that covert brain infarcts (CBIs) are more likely to be located in noneloquent brain areas compared with clinical strokes and that CBI etiological subtypes carry a differential risk of vascular events compared with people without CBI. Methods- We used brain magnetic resonance imaging from 1290 stroke-free participants in the NOMAS (Northern Manhattan Study) to evaluate for CBI. We classified CBI as cardioembolic (ie, known atrial fibrillation), large artery atherosclerosis (extracranial and intracranial), penetrating artery disease, and cryptogenic (no apparent cause). CBI localized in the nonmotor areas of the right hemisphere were considered noneloquent. We then evaluated risk of events by CBI subtype with adjusted Cox proportional models. Results- At the time of magnetic resonance imaging, 236 participants (18%) had CBI (144 [61%] distal cryptogenic, 29 [12%] distal cardioembolic, 26 [11%] large artery atherosclerosis, and 37 [16%] penetrating artery disease). Smaller (per mm, odds ratio, 0.8 [0.8-0.9]) and nonbrain stem infarcts (odds ratio, 0.2 [0.1-0.6]) were more likely to be covert. During the follow-up period (10.4±3.1 years), 398 (31%) died (162 [13%] of vascular death) and 117 (9%) had a stroke (99 [85%]) were ischemic. Risks of events varied by CBI subtype, with the highest risk of stroke (hazard ratio, 2.2 [1.3-3.7]) and vascular death (hazard ratio, 2.24 [1.29-3.88]) noted in participants with intracranial large artery atherosclerosis-related CBI. Conclusions- CBI can be classified into subtypes that have differential outcomes. Certain CBI subtypes such as those related to intracranial large artery atherosclerosis have a high risk of adverse vascular outcomes and could warrant consideration of treatment trials.

Original languageEnglish (US)
Pages (from-to)90-98
Number of pages9
JournalStroke
Volume51
Issue number1
DOIs
StatePublished - Jan 1 2020

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Blood Vessels
Brain
Arteries
Stroke
Atherosclerosis
Odds Ratio
Magnetic Resonance Imaging
Intracranial Arteriosclerosis
Proportional Hazards Models
Atrial Fibrillation

Keywords

  • atherosclerosis
  • atrial fibrillation
  • brain infarction
  • magnetic resonance imaging
  • risk factors

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Gutierrez, J., Gil-Guevara, A., Ramaswamy, S., DeRosa, J., Di Tullio, M. R., Cheung, K., ... Elkind, M. S. V. (2020). Classification of Covert Brain Infarct Subtype and Risk of Death and Vascular Events. Stroke, 51(1), 90-98. https://doi.org/10.1161/STROKEAHA.119.026068

Classification of Covert Brain Infarct Subtype and Risk of Death and Vascular Events. / Gutierrez, Jose; Gil-Guevara, Andrea; Ramaswamy, Srinath; DeRosa, Janet; Di Tullio, Marco R.; Cheung, Ken; Rundek, Tatjana; Sacco, Ralph L.; Wright, Clinton B.; Elkind, Mitchell S.V.

In: Stroke, Vol. 51, No. 1, 01.01.2020, p. 90-98.

Research output: Contribution to journalArticle

Gutierrez, J, Gil-Guevara, A, Ramaswamy, S, DeRosa, J, Di Tullio, MR, Cheung, K, Rundek, T, Sacco, RL, Wright, CB & Elkind, MSV 2020, 'Classification of Covert Brain Infarct Subtype and Risk of Death and Vascular Events', Stroke, vol. 51, no. 1, pp. 90-98. https://doi.org/10.1161/STROKEAHA.119.026068
Gutierrez J, Gil-Guevara A, Ramaswamy S, DeRosa J, Di Tullio MR, Cheung K et al. Classification of Covert Brain Infarct Subtype and Risk of Death and Vascular Events. Stroke. 2020 Jan 1;51(1):90-98. https://doi.org/10.1161/STROKEAHA.119.026068
Gutierrez, Jose ; Gil-Guevara, Andrea ; Ramaswamy, Srinath ; DeRosa, Janet ; Di Tullio, Marco R. ; Cheung, Ken ; Rundek, Tatjana ; Sacco, Ralph L. ; Wright, Clinton B. ; Elkind, Mitchell S.V. / Classification of Covert Brain Infarct Subtype and Risk of Death and Vascular Events. In: Stroke. 2020 ; Vol. 51, No. 1. pp. 90-98.
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abstract = "Background and Purpose- To test the hypothesis that covert brain infarcts (CBIs) are more likely to be located in noneloquent brain areas compared with clinical strokes and that CBI etiological subtypes carry a differential risk of vascular events compared with people without CBI. Methods- We used brain magnetic resonance imaging from 1290 stroke-free participants in the NOMAS (Northern Manhattan Study) to evaluate for CBI. We classified CBI as cardioembolic (ie, known atrial fibrillation), large artery atherosclerosis (extracranial and intracranial), penetrating artery disease, and cryptogenic (no apparent cause). CBI localized in the nonmotor areas of the right hemisphere were considered noneloquent. We then evaluated risk of events by CBI subtype with adjusted Cox proportional models. Results- At the time of magnetic resonance imaging, 236 participants (18{\%}) had CBI (144 [61{\%}] distal cryptogenic, 29 [12{\%}] distal cardioembolic, 26 [11{\%}] large artery atherosclerosis, and 37 [16{\%}] penetrating artery disease). Smaller (per mm, odds ratio, 0.8 [0.8-0.9]) and nonbrain stem infarcts (odds ratio, 0.2 [0.1-0.6]) were more likely to be covert. During the follow-up period (10.4±3.1 years), 398 (31{\%}) died (162 [13{\%}] of vascular death) and 117 (9{\%}) had a stroke (99 [85{\%}]) were ischemic. Risks of events varied by CBI subtype, with the highest risk of stroke (hazard ratio, 2.2 [1.3-3.7]) and vascular death (hazard ratio, 2.24 [1.29-3.88]) noted in participants with intracranial large artery atherosclerosis-related CBI. Conclusions- CBI can be classified into subtypes that have differential outcomes. Certain CBI subtypes such as those related to intracranial large artery atherosclerosis have a high risk of adverse vascular outcomes and could warrant consideration of treatment trials.",
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AU - Di Tullio, Marco R.

AU - Cheung, Ken

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