Determinants of stroke recurrence in a nationwide multicenter cohort
Nazlı Gamze Bülbül1
, Bilge Piri Çınar2, Refik Kunt3, Burcu Yüksel4, Halil Güllüoğlu5, İdris Saylır6, Sibel Çeliker Uslu7, Eylem Özaydın Göksu8, Baykal Yıldız9, Didem Öz10, Ahmet Onur Keskin11, Osman Korucu12, Çetin Kürşad Akpınar2, Volkan Solmaz13, Meliha Türksever13, Fatma Zehra Altunç8, Zeynep Elmas14, Mustafa Ekici15, Murat Mert Atmaca1, Sibel Karşıdağ1, Mehmet Fatih Özdağ1
1Department of Neurology, University of Health Sciences, Sultan Abdülhamid Han Training and Research Hospital, İstanbul, Türkiye
2Department of Neurology, Samsun University Faculty of Medicine, Samsun, Türkiye
3Department of Neurology, İzmir Democracy University Faculty of Medicine, İzmir, Türkiye
4Department of Neurology, İstanbul Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Hospital, İstanbul, Türkiye
5Department of Neurology, Medicalpoint International İzmir Hospital, İzmir, Türkiye
6Department of Neurology, University of Health Sciences, Samsun Training and Research Hospital, Samsun, Türkiye
7Department of Neurology, İstanbul Univesity Faculty of Medicine, İstanbul, Türkiye
8Department of Neurology, Antalya Research and Training Hospital, Antalya, Türkiye
9Department of Neurology, Kocaeli Darıca Farabi Research and Training Hospital, Kocaeli, Türkiye
10Department of Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Türkiye
11Department of Neurology, Eskişehir City Hospital, Eskişehir, Türkiye
12Department of Neurology, Atatürk Sanatoryum Research and Training Hospital, Ankara, Türkiye
13Department of Neurology, Trakya University Faculty of Medicine, Edirne, Türkiye
14Department of Neurology, Medicalpark İzmir Hospital, İzmir, Türkiye
15Emergency Medicine, Atatürk State Hospital, Aydın, Türkiye
Keywords: Acute stroke, carotid artery stenosis, risk factors, secondary prevention, stroke recurrence.
Abstract
Objectives: This multicenter study aimed to identify the clinical, laboratory, and demographic determinants associated with stroke recurrence in a large nationwide cohort of patients presenting with acute stroke.
Patients and methods: This retrospective multicenter cohort study included 1,132 patients (614 males, 518 females; mean age: 70.0 ± 12.6 years) who hospitalized with acute stroke across tertiary centers in Türkiye between February 2016 and December 2024. Sociodemographic characteristics, vascular risk factors, clinical presentation, laboratory parameters, neuroimaging findings, and clinical outcomes were obtained from hospital records. Stroke recurrence was defined as the primary endpoint. Bivariate analyses were initially performed to evaluate associations between potential predictors and recurrence, followed by multivariate logistic regression analysis to determine independent determinants.
Results: Stroke recurrence occurred in 24.3% of the cohort. In bivariate analyses, recurrence was significantly associated with hypertension (odds ratio [OR] = 1.677, p = 0.002), hyperlipidemia (OR = 1.575, p = 0.01), diabetes mellitus (OR = 1.390, p = 0.025), atrial fibrillation (OR = 2.531, p < 0.001), and carotid artery stenosis (OR = 3.085, p < 0.001). However, in multivariate logistic regression analysis, only advanced age (OR = 1.030, p < 0.001) and carotid artery stenosis (OR = 3.085, p < 0.001) remained independent predictors of stroke recurrence.
Conclusion: Advanced age and carotid artery stenosis emerged as the strongest independent determinants of stroke recurrence in this nationwide multicenter cohort. These findings highlight the importance of early vascular evaluation and individualized risk stratification to improve secondary stroke prevention strategies.
Cite this article as: Bülbül HG, Çınar BP, Kunt R, Yüksel B, Güllüoğlu H, Saylır İ, et al. Determinants of stroke recurrence in a nationwide multicenter cohort. Turk J Neurol 2026;32(2):155-164. https://doi.org/10.55697/tnd.2026.613.
The data that support the findings of this study are available from the corresponding author upon reasonable request.
N.G.B., B.P.Ç., R.K., S.K.: Idea/concept, design, analysis and/or interpretation, literature review; B.P.Ç., M.F.Ö., S.K.: Control/supervision, critical review; N.G.B., B.P.Ç., R.K., B.Y., H.G., İ.S., S.Ç.U., E.Ö.G., B.Y., D.Ö., A.O.K., O.K., Ç.K.A., V.S., M.A., F.Z.A., Z.E., M.E., M.M.A., S.K., M.F.Ö.: Data collection and/or processing; N.G.B., B.P.Ç., S.K.: Writing the article.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.
The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.