MRI-defined acute cerebral infarctions (DWI+) and carotid plaque haemorrhage (MRIPH+) are risk factors for cerebrovascular ischaemic events. It is unclear whether their predictive power is independent, and whether a combined score would improve prediction of recurrent events.Methods
158 patients (mean 74 years, 40% female) with symptomatic (n=69 TIA)≥50% carotid stenosis underwent carotid and brain MRI, and clinical follow-up. Multivariate backward regression and Kaplan Meier survival analyses were used for event prediction. Akaike information criterion (AIC) values for single and combined models were compared.Results
83/158 patients were DWI+and 88/158 MRIPH+. 41 recurrent events were observed, and both DWI+ (HR 2.85; 95% CI 1.2–7; p=0.024) and MRIPH+ (HR 7.6; 95% CI 2.2–26.4; p=0.001) were independent predictors. The AIC value for the combined model (AIC 200.1) showed added value vs. DWI (AIC 220.5) and MRIPH (AIC 204.9). Survival analysis for patients with an index TIA illustrated significant shorter stroke-free survival (χ2=12.5, p<0.001) and event-free survival (χ2=11.1, p=0.001) for DWI+versus DWI- patients.Conclusion
Brain DWI +and MRIPH +are independent predictors of recurrent stroke in symptomatic carotid disease with added prediction value for the combined model.