Prognosis of incidentally detected asymptomatic intracranial atherosclerotic stenosis: A prospective hospital-based cohort study

作者：Yiyang Liu, Yinxi Zou, Huanyu Zhou, Manqiu Ding, Ningyuan Liu, Haoyao Guo, Yuelun Zhang, Yuexuan Dai, Xin Li, Yinghuan Hu, Caiyan Liu, Shan Gao, Yan Xu, Weihai Xu · 发表于：International Journal of Stroke · 年份：2025 · DOI：10.1177/17474930251383855 · 被引用次数：1 · 研究领域：Cerebrovascular and Carotid Artery Diseases、Acute Ischemic Stroke Management、Coronary Interventions and Diagnostics

BACKGROUND: Asymptomatic intracranial atherosclerotic stenosis (ICAS) is frequently identified in stroke screening programs, particularly in Asian populations. However, the prognosis and management strategies for incidentally detected asymptomatic ICAS in hospital-based, stroke-free populations remain unclear. AIMS: This study aimed to investigate the incidence of symptomatic transition and associated long-term prognostic evolution in this population, providing evidence to inform primary stroke prevention. METHODS: We conducted a prospective cohort study that included 1004 patients with asymptomatic ICAS (⩾50%) screened by transcranial Doppler ultrasound (TCD) between January 2016 and May 2022, with follow-up through August 2023. Using the Fine and Gray competing risk model, we analyzed the incidence of symptomatic transition, defined as a first-ever ischemic stroke or transient ischemic attack occurring within the ICAS territory. Post-transition outcomes, including recurrent stroke, major adverse cardiovascular events (MACE), disability (modified Rankin Scale score > 2), and patient-reported cognitive decline (Everyday Cognition-12 score ⩾ 2), were evaluated by comparative analysis. RESULTS: Over a median follow-up of 3.7 years (IQR 2.4-5.2), 43 (4.3%) patients with asymptomatic ICAS experienced a symptomatic transition under routine clinical surveillance, yielding a 5-year cumulative transition rate of 5.6%. After adjusting for potential confounders, hypertension (hazard ra...