To investigate the risk and predictors of stroke recurrence in patients with symptomatic intracranial internal carotid artery (IICA) stenosis.

Consecutive patients with first-ever ischemic stroke or transient ischemic attack (TIA) caused by IICA atherosclerotic stenosis were enrolled prospectively. The patients were regularly followed up to assess stroke recurrence.

A total of 70 patients were enrolled, 49 patients were males, and the mean age was 68.2±12.3 years. The mean follow-up time was 34±17 months (median, 33 months). Twenty-seven patients (38.6%) experienced recurrent events during the follow-up period (5 TIAs and 22 ischemic strokes); 92.6% of recurrent events occurred in the original symptomatic stenotic IICA territory. Internal watershed infarction in patients with recurrent stroke was more common than those without stroke recurrence (74.1% vs. 44.2%, P=0.025). Kaplan-Meier survival analysis showed that the risks of stroke recurrence at 1, 3 and 5 years were 26.8%, 42.5%, and 46.9%, respectively in patients with symptomatic IICA stenosis. Multivariate Cox proportional risk regression analysis showed that the predictors for stroke recurrence in patients with symptomatic IICA stenosis included diabetes (hazard risk [HR] 3.68, 95% confidence interval [CI] 1.43-9.46; P=0.007), combined asymptomatic intracranial artery occlusive disease (HR 2.95, 95% CI 1.16-7.50; P=0.023), and internal watershed infarction (HR 4.50, 95% CI 1.43-14.17; P=0.010) after adjusting for sex, age and traditional vascular risk factors.

The risk of long-term stroke recurrence in patients with symptomatic IICA stenosis is still high under the current drug treatment. Diabetes, combined asymptomatic intracranial arterial occlusive disease, and internal watershed infarction are closely associated with stroke recurrence.

Stroke; Brain Ischemia; Intracranial Arteriosclerosis; Carotid Stenosis; Prognosis; Recurrence; Risk Factors