Background: Early recurrent ischemic lesions (ERILs) on diffusion-weighted imaging (DWI) after acute ischemic stroke have been considered as a potential marker of early recurrent symptomatic stroke. The aim of this study to explore the impact of High-sensitivity C-reactive protein (hsCRP) levels at different time points on ERILs.
Method: We prospectively enrolled 484 patients with acute ischemic stroke who underwent DWI and whose plasma and serum biomarkers (hsCRP, D-dimer, and brain natriuretic protein [BNP]) within 24 hours of onset and subsequently at 7 days after onset. Baseline characteristics, stroke features, initial National Institutes of Health Stroke Scale (NIHSS) score, and DWI lesion volume were recorded. ERILs were defined as new ischemic lesions on 7-day DWI, which were outside the vascular territory of index stroke with arterial occlusion and the same or outside the vascular territory of index stroke with arterial stenosis.
Results: ERILs were observed in 146 patients (30.2%). In univariate analysis, atrial fibrillation (p=0.040), higher initial NIHSS score (p<0.001), larger DWI infarct volume (p<0.001), stroke subtype (p<0.001), elevated initial and follow-up BNP (p=0.014 and p=0.003) and D-dimer (p=0.009 and p=0.011), and elevated follow-up hsCRP (p<0.001) were positively associated and combination of anticoagulation and antiplatelet therapy after admission (p=0.002) was negatively associated with ERILs. In multivariate analysis, combination of anticoagulation and antiplatelet therapy after admission (Odds ratio [OR], 0.462; 95% confident interval [CI], 0.272 to 0.785; p=0.004) and follow-up log hsCRP (OR, 1.389; 95% CI, 1.054 to 1.830; p=0.020) were independent predictors of ERILs.
Conclusions: Underlying inflammation after acute ischemic stroke may be associated with ERILs.