Background
The investigation of ischemic stroke etiology is commonly limited to the heart and
extracranial vessels. Nevertheless, the diagnosis of intracranial stenosis may carry
important therapeutic implications. The aims of this study were to determine the prevalence
and clinical predictors of intracranial atherosclerotic stenosis (ICAS) in a sample
of patients with ischemic stroke.
Methods
Consecutive patients admitted to a university-based outpatient stroke clinic underwent
CT angiography of the intracranial and extracranial brain vessels. Clinical, demographic,
and laboratory characteristics were compared between patients with increasing levels
of stenosis. Ankle-brachial index (ABI) was measured to quantify peripheral arterial
disease, defined as an ABI less than or equal to .9. Multivariable ordinal logistic
regression was constructed to predict increasing stenosis grades (none, 1%-49%—mild,
50%-69%—moderate, 70%-100%—severe).
Results
We studied 106 subjects, mean age 62 ± 15 years, 54% female. ICAS was present in 38
(36%) patients: 19 (50%) mild, 7 (18%) moderate, and 12 (32%) severe. Of 74 patients
where ABI was measured, low ABI was found more frequently with increasing ICAS severity
(26%, 42%, 67%, and 89% of patients with none, mild, moderate, and severe ICAS, respectively).
In univariable analysis, higher age, presence of diabetes, abdominal obesity, and
low ABI correlated with increasing stenosis grades. In multivariable analysis, only
low ABI remained independently associated with increasing stenosis grades.
Conclusions
The ABI is independently associated with increasing severity of ICAS, making it a
potentially useful triaging tool for more invasive test selection.
Key Words
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References
- Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study.Stroke. 1995; 26: 14
- Prevalence of asymptomatic intracranial atherosclerosis in high-risk patients.Neurology. 2007; 68: 2035-2038
- A door-to-door survey of intracranial atherosclerosis in Liangbei County, China.Neurology. 2007; 68: 2031-2034
- The Barcelona Asymptomatic Intracranial Atherosclerosis (AsIA) study: prevalence and risk factors.Atherosclerosis. 2012; 221: 221-225
- Frequency and determinants of intracranial atherosclerotic stroke in urban Pakistan.J Stroke Cerebrovasc Dis. 2014; 23: 2174-2182
- Predictors of symptomatic and asymptomatic intracranial atherosclerosis: what is different and why?.J Atheroscler Thromb. 2014; 21: 605-617
- Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China: the Chinese Intracranial Atherosclerosis (CICAS) Study.Stroke. 2014; 45: 663-669
- Influence of arterial disease on the systolic blood pressure gradients of the extremity.Am J Med Sci. 1950; 220: 117-126
- ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic).Circulation. 2006; 113: e463-e654
- Co-existence of carotid artery disease, renal artery stenosis, and lower extremity peripheral arterial disease in patients with coronary artery disease.Am J Cardiol. 2014; 113: 30-35
- Prevalence and severity of asymptomatic coronary and carotid artery disease in patients with lower limbs arterial disease.Atherosclerosis. 2013; 228: 386-389
- Prevalence and risk factors of middle cerebral artery stenosis in asymptomatic residents in Rongqi County, Guangdong.Cerebrovasc Dis. 2007; 24: 111-115
- Risk factors of intracranial cerebral atherosclerosis among asymptomatics.Cerebrovasc Dis. 2007; 24: 355-360
- Prevalence of symptomatic intracranial atherosclerosis in Caucasians: a prospective, multicenter, transcranial Doppler study.J Neuroimaging. 2012; 24: 11-17
- Risk factors for occlusive lesions of intracranial arteries in stroke-free Japanese.Eur J Neurol. 2005; 12: 218-222
- Role of abdominal obesity in asymptomatic intracranial arterial stenosis: a community-based study.Zhonghua Yi Xue Za Zhi. 2010; 90: 748-751
- Strong and significant relationships between aggregation of major coronary risk factors and the acceleration of carotid atherosclerosis in the general population of a Japanese city: the Suita Study.Arch Intern Med. 2000; 160: 2297
- Risk factors associated with severity and location of intracranial arterial stenosis.Stroke. 2010; 41: 1636
- Race-ethnic differences in stroke risk factors among hospitalized patients with cerebral infarction: the Northern Manhattan Stroke Study.Neurology. 1995; 45: 659
- Predictors of intracranial carotid artery atherosclerosis. Duration of cigarette smoking and hypertension are more powerful than serum lipid levels.Arch Neurol. 1991; 48: 687
Article info
Publication history
Published online: March 22, 2016
Accepted:
January 29,
2016
Received:
August 31,
2015
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.01.049
Copyright
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
