Analysis of risk factors and identification of high-risk patients for recurrent stroke in symptomatic intracranial and extracranial atherosclerotic stenosis
Tian Xue, Xia Xue, Zhou Quan, Yang Weizi, Hao Yunyi, Sun Yue, Wang Anxin, Zhang Tong
2026, 47(1):
43-53.
doi:10.3969/j.issn.1006-7795.2026.01.006
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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.
