Journal of Capital Medical University ›› 2026, Vol. 47 ›› Issue (1): 43-53.doi: 10.3969/j.issn.1006-7795.2026.01.006

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Analysis of risk factors and identification of high-risk patients for recurrent stroke in symptomatic intracranial and extracranial atherosclerotic stenosis

Tian Xue1,2,3, Xia Xue1,2,3, Zhou Quan1,2,3, Yang Weizi1,2,3, Hao Yunyi1,2,3, Sun Yue1,2,3, Wang Anxin1,2,3, Zhang Tong1,2*   

  1. 1.Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; 2.National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; 3.Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing  100070, China
  • Received:2025-10-24 Revised:2025-11-18 Online:2026-02-21 Published:2026-02-02
  • Supported by:
    This study was supported by the Noncommunicable Chronic Diseases-National Science and Technology Major Project (2023ZD0505201).

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Abstract: Objective  To screen and validate risk factors associated with stroke recurrence in Chinese patients with symptomatic intracranial and extracranial atherosclerotic stenosis and to identity patients at high-risk of stroke recurrence. Methods  This study utilized data from the Third China National Stroke Registry. Patients with stroke and ≥50% intracranial or extracranial arterial stenosis were included. The data collected included demographic characteristics, medical history, prehospital care, physical examination findings on admission, admission scores, imaging information, discharge diagnoses, and laboratory parameters. The primary outcome was ascertained as stroke recurrence within 3 months. Cox proportional hazards regression was used to identify independent risk factors for stroke recurrence in symptomatic intracranial and extracranial atherosclerotic stenosis patients. A prediction model for 3-month stroke recurrence was developed based on the identified factors and its predictive performance was compared with the traditional ESSEN score. Results  Among 3 944 enrolled patients (median age 64 years,  67.8% male), 324 (8.7%) patients experienced stroke recurrence within 3 months. Multivariable Cox regression analysis identified the following independent risk factors for recurrence: age≥75 years (HR=1.36, 95% CI: 1.06-1.76, P=0.016), time from onset to admission <72 h (HR=1.64, 95% CI: 1.14-2.35, P=0.007), admission National Institutes of Health Stroke Scale (NIHSS) >5 (HR=3.38, 95% CI: 1.13-10.14, P=0.029), non-lacunar infarction (HR=1.71, 95% CI: 1.13-2.57, P=0.011), and elevated plasma interleukin-6 level (HR=1.02, 95% CI: 1.00-1.05, P=0.040). The novel prediction model demonstrated superior discriminative ability compared to the ESSEN score, with the C-statistic increasing from 0.557 to 0.616 (P=0.003). Significant improvements were also observed in integrated discrimination improvement (IDI=0.79%, 95% CI： 0.44%-1.14%, P<0.001) and net reclassification index (NRI=21.34%, 95% CI: 10.88%-31.80%, P<0.001).Conclusion  In Chinese patients with symptomatic intracranial and extracranial atherosclerotic stenosis, age≥75 years, onset-to-admission time <72 h, admission NIHSS >5, non-lacunar infarction, and elevated plasma interleukin-6 levels are independent risk factors for 3-month stroke recurrence. The prediction model incorporating these factors outperforms the conventional ESSEN score in identifying patients at high-risk of stroke recurrence.

Key words: symptomatic intracranial and extracranial arterial stenosis, stroke recurrence, risk factors, high-risk population, secondary prevention, cohort study

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