Abstract
INTRODUCTION: Intracranial atherosclerosis (ICAS) is a progressive disease that leads to narrowing of the brain's arteries and reduced blood flow, making it a leading cause of both initial and recurrent strokes worldwide. Various contributing factors influence its development. Despite advanced neuroimaging and therapeutic interventions, the management of ICAS remains a concern. Our study examines the risk factors and outcomes of ischemic stroke due to ICAS in a tertiary care facility. METHODS: This prospective study examines 100 patients with ICAS-related acute ischemic stroke. Diagnosis was established by magnetic resonance angiography (MRA). Clinical assessments, imaging studies, laboratory tests, and follow-up evaluations were performed over a 12-month period. Recurrence of stroke and function status were evaluated using multivariate Cox regression analysis and Kaplan-Meier survival curves. RESULTS: Dominant risk factors were hypertension, seen in 82 (82%) patients, followed by diabetes mellitus, which was seen in 52 (52%) patients. Smoking as a risk factor was reported in 34 (34%) cases, followed by hyperlipidemia, which was seen in 29 (29%) cases. The middle cerebral artery was involved in 53 (53%) patients. Stroke recurrence occurred in 17 (17%) patients within the first three months. The independent presence of three or more risk factors raised recurrence risk (p=0.035). Dual antiplatelet and statin therapies significantly reduced recurrence (p<0.05). Smoking and higher National Institutes of Health Stroke Scale (NIHSS) scores were linked to worse functional outcomes. CONCLUSION: This study confirms a greater prevalence of intracranial atherosclerotic stroke among men. Intensive medical treatment, such as incorporating dual antiplatelet therapy, statins, and strict management of diabetes and hypertension, showed a significant reduction in recurrence rates.