Abstract Body: Background: Intracranial artery stenosis (ICAS) is a progressive pathological process. No study has focused on changes in long-term disease burden associated with the progression from asymptomatic to symptomatic ICAS stages, which inform future preventive strategies and health management.
Methods: We performed an ambispective cohort study that included consecutive patients with 50% or greater ICAS diagnosed by transcranial Doppler from January 2016 to May 2022. All patients received follow-ups through August 2023. The primary outcomes were ischemic stroke, all-cause mortality, and global cognitive decline.
Results: Of 1872 eligible patients, 1628 (87.0%) were interviewed (1004 [61.7%] with asymptomatic ICAS; 624 [38.3%] with symptomatic ICAS). The mean age of the patients was 62.4±13.3 years. During a median follow-up of 3.7 years (IQR, 2.4-5.2), 60 (6.0%) patients with asymptomatic ICAS had a first-ever ischemic stroke, 63 (6.3%) died, and 7.6% had self-reported cognitive decline (global Everyday Cognition scale ≥ 2). During a median follow-up of 3.8 years (IQR, 2.2–5.4), 98 (15.7%) patients with symptomatic ICAS had recurrent ischemic stroke, 93 (14.9%) died, and 18.2% had self-reported cognitive decline. The cumulative incidence of ischemic stroke and all-cause mortality by five years were 7.5% (95% CI, 5.4%-9.6%) and 7.7% (95% CI, 5.5%-9.9%) among patients with asymptomatic ICAS, while those in patients with symptomatic ICAS were 18.2% (95% CI, 14.7%-21.8%) and 17.9% (95% CI, 14.0%-21.8%), respectively. Symptomatic ICAS conveyed an increased hazard of ischemic stroke (adjusted HR 2.54, 95% CI 1.82–3.54; P < 0.001) and all-cause mortality (adjusted HR 2.27, 95% CI 1.63-3.16; P < 0.001) compared with asymptomatic ICAS. In multivariable analysis, only hypertension independently predicted stroke occurrence in the asymptomatic ICAS group (adjusted HR 4.06, 95%CI 1.60-10.33, P = 0.003).
Conclusions: The long-term disease burden increases 2-3-fold when asymptomatic ICAS progresses to symptomatic ICAS. Our study underscores the necessity of intensive management, particularly blood pressure control, for primary stroke prevention in patients with asymptomatic ICAS.