BACKGROUND AND PURPOSE Intracranial arterial stenosis (ICAS)-related stroke occurs due to three primary mechanisms with distinct infarct patterns: (1) borderzone infarcts (BZI) due to impaired distal perfusion, (2) territorial infarcts due to distal plaque/thrombus embolization, and (3) plaque progression occluding perforators. The objective of the systematic review is to determine whether BZI secondary to ICAS is associated with a higher risk of recurrent stroke or neurological deterioration. METHODS As part of this registered systematic review (CRD42021265230), a comprehensive search was performed to identify relevant papers and conference abstracts (with ≥20 patients) reporting initial infarct patterns and recurrence rates in patients with symptomatic ICAS. Subgroup analyses were performed for studies including any BZI versus isolated BZI and those excluding posterior circulation stroke. The study outcome included neurological deterioration or recurrent stroke during follow-up. For all outcome events, corresponding risk ratios (RRs) and 95% confidence intervals (95% CI) were calculated. RESULTS A literature search yielded 4,478 records with 32 selected during the title/abstract triage for full text; 11 met inclusion criteria and 8 studies were included in the analysis (n=1,219 patients; 341 with BZI). The meta-analysis demonstrated that the RR of outcome in the BZI group compared to the no BZI group was 2.10 (95% CI 1.52-2.90). Limiting the analysis to studies including any BZI, the RR was 2.10 (95% CI 1.38-3.18). For isolated BZI, RR was 2.59 (95% CI 1.24-5.41). RR was 2.96 (95% CI 1.71-5.12) for studies only including anterior circulation stroke patients. CONCLUSION This systematic review and meta-analysis suggests that the presence of BZI secondary to ICAS may be an imaging biomarker that predicts neurological deterioration and/or stroke recurrence.

中文翻译：

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有症状的颅内动脉狭窄的边界区梗死和复发性脑血管事件：系统评价和荟萃分析。

背景和目的 颅内动脉狭窄 (ICAS) 相关卒中的发生是由于具有不同梗死模式的三种主要机制：(1) 由于远端灌注受损导致的边界区梗死 (BZI)，(2) 由于远端斑块/血栓栓塞导致的区域性梗死， (3) 斑块进展阻塞穿支。系统评价的目的是确定继发于 ICAS 的 BZI 是否与更高的卒中复发或神经功能恶化风险相关。方法 作为该注册系统评价 (CRD42021265230) 的一部分，进行了全面搜索，以确定报告有症状 ICAS 患者初始梗死模式和复发率的相关论文和会议摘要（≥ 20 名患者）。对包括任何 BZI 与孤立 BZI 以及排除后循环卒中的研究进行了亚组分析。研究结果包括随访期间神经功能恶化或中风复发。对于所有结果事件，计算了相应的风险比 (RR) 和 95% 置信区间 (95% CI)。结果 文献检索产生了 4,478 条记录，其中 32 条在全文的标题/摘要分类过程中被选中；11 项符合纳入标准，8 项研究被纳入分析（n=1,219 名患者；341 名患有 BZI）。荟萃分析表明，与无 BZI 组相比，BZI 组的结果 RR 为 2.10（95% CI 1.52-2.90）。将分析限制在包括任何 BZI 的研究中，RR 为 2.10（95% CI 1.38-3.18）。对于孤立的 BZI，RR 为 2.59（95% CI 1.24-5.41）。RR 为 2.96（95% CI 1.71-5。12) 仅包括前循环卒中患者的研究。结论 该系统回顾和荟萃分析表明，继发于 ICAS 的 BZI 的存在可能是预测神经功能恶化和/或卒中复发的影像学生物标志物。