Borderzone Infarcts and Recurrent Cerebrovascular Events in Symptomatic Intracranial Arterial Stenosis: A Systematic Review and Meta-Analysis

Saurav Das, Liqi Shu, Rebecca J. Morgan, Asghar Shah, Fayez H. Fayad, Eric D. Goldstein, Dalia Chahien, Benton Maglinger, Satish Kumar Bokka, Cory Owens, Mehdi Abbasi, Alexandra Kvernland, James E. Siegler, Brian Mac Grory, Thanh N. Nguyen, Karen Furie, Pooja Khatri, Eva Mistry, Shyam Prabhakaran, David S. LiebeskindJose G. Romano, Adam de Havenon, Lina Palaiodimou, Georgios Tsivgoulis, Shadi Yaghi

Research output: Contribution to journalReview articlepeer-review

5 Scopus citations


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.

Original languageEnglish
Pages (from-to)223-232
Number of pages10
JournalJournal of Stroke
Issue number2
StatePublished - May 2023

Bibliographical note

Publisher Copyright:
© 2023 Korean Stroke Society.


  • Borderzone Infarct
  • Intracranial arterial diseases
  • Intracranial atherosclerosis
  • Recurrence
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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