Are Arterial Calcifications a Marker of Remodeling in Vertebrobasilar Territory?

Pikija, Slaven; Magdič, Jožef; Knific, Alenka

doi:10.1161/strokeaha.113.003518

Cited by 11 publications

(8 citation statements)

References 12 publications

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“…Previous studies have revealed the correlation between luminal stenosis and the severity (thickness and circularity) of calcification in the intracranial ICA ( 76 , 77 ). In contrast, medial calcification seems to be more associated with vascular remodeling than luminal narrowing ( 78 ) in the vertebral artery and coronary artery ( 79 ). No significant correlation between medial calcification and luminal stenosis has been established yet ( 10 ).…”

Section: Clinical Relevance Of Iacmentioning

confidence: 99%

Histology-Verified Intracranial Artery Calcification and Its Clinical Relevance With Cerebrovascular Disease

Yang

Chen

2022

Front. Neurol.

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Intracranial artery calcification (IAC) was regarded as a proxy for intracranial atherosclerosis (ICAS). IAC could be easily detected on routine computer tomography (CT), which was neglected by clinicians in the previous years. The evolution of advanced imaging technologies, especially vessel wall scanning using high resolution-magnetic resonance imaging (HR-MRI), has aroused the interest of researchers to further explore the characteristics and clinical impacts of IAC. Recent histological evidence acquired from the human cerebral artery specimens demonstrated that IAC could mainly involve two layers: the intima and the media. Accumulating evidence from histological and clinical imaging studies verified that intimal calcification is more associated with ICAS, while medial calcification, especially the internal elastic lamina, contributes to arterial stiffness rather than ICAS. Considering the highly improved abilities of novel imaging technologies in differentiating intimal and medial calcification within the large intracranial arteries, this review aimed to describe the histological and imaging features of two types of IAC, as well as the risk factors, the hemodynamic influences, and other clinical impacts of IAC occurring in intimal or media layers.

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Section: Clinical Relevance Of Iacmentioning

confidence: 99%

Histology-Verified Intracranial Artery Calcification and Its Clinical Relevance With Cerebrovascular Disease

Yang

Chen

2022

Front. Neurol.

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“…We added the total number of slices with calcifications to this score. Thus, the score incorporates both horizontal and vertical dispersion of calcifications and yields an ordinal scale that ranges from 1 to 19 [7,8]. Furthermore, we noted details of the calcification pattern, which included focal, crescent, and circular IAC.…”

Section: Evaluation Of Intracranial Calcificationmentioning

confidence: 99%

“…Intracranial artery calcification (IAC) is a common finding on nonenhanced computer tomography (NECT) of the brain in elderly patients, especially in patients with vascular risk factors [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…In this regard, both a population and a hospital-based cohort study showed that IAC is linked to a higher rate of stroke, independently of cardiovascular comorbidity [12,14]. There is limited knowledge about IAC of the vertebrobasilar vessels (VBC) and contribution of its presence to stroke recurrence, vascular events, or death [7,8]. Previous studies disclosed a risk for early vascular events, and confirmation on the long-term risk would have significant implications on secondary prophylaxis and subsequent follow-up examination [15].…”

Section: Introductionmentioning

confidence: 99%

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Intracranial Vertebrobasilar Calcification in Patients with Ischemic Stroke Is a Predictor of Recurrent Stroke, Vascular Disease, and Death: A Case-Control Study

Magdič

Cmor

Kaube

et al. 2020

IJERPH

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Intracranial artery calcification can be detected on nonenhanced brain computer tomography (NECT) and is a predictor of early vascular events. Here, we assessed the impact of vertebrobasilar artery calcification (VBC) on the long-term risk for recurrent stroke and vascular events. We performed a case-control trial of all consecutive stroke patients admitted to the University Hospital of Maribor, Slovenia over a period of 14 months. VBC was defined as presence of a hyperdense area within vertebrobasilar arteries that exceeds > 90 Hounsfield units as seen on NECT. Clinical follow-up information was obtained from the hospital documentation system and mortality registry of the district and included recurrent stroke, subsequent vascular events (myocardial infarction, heart failure, peripheral arterial occlusive disease), and death. We followed a total of 448 patients for a median of 1505 days (interquartile range, IQR 188-2479). Evidence for VBC was present in 243 (54.2%) patients. Median age was 76 years, recurrent stroke occurred in 33 (7.4%), any vascular events in 71 (15.8%), and death in 276 (61.6%). VBC was associated with a higher risk of recurrent stroke (hazard ratio, HR 3.13, 95% confidence interval ) and vascular events (HR 2.05, 95% CI 1.21-3.47). Advanced age, male gender, and ischemic stroke involving the entire anterior circulation raised the likelihood for death. We conclude that the presence of VBC in patients with ischemic stroke is a shortand long-term prognostic factor for stroke recurrence and subsequent manifestation of acute vascular disease. Further understanding of the pathophysiology of VBC is warranted.

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“…The mainstay of therapy is identification of ILAA using non-invasive neuroimaging, and mediation of various risk factors such as hyperlipidemia and diabetes. Currently, the presence of ILAA is presumed by the presence of focal luminal narrowing on lumen-based imaging such as brain CTA or MRA or by identifying the presence of arterial calcifications on brain CT. 3 However, not all brain arterial stenosis are atherosclerotic, as in cases of fibromuscular dysplasia or large artery vasculitis, 4, 5 . Further, many atherosclerotic plaques have only modest degrees of luminal stenosis.…”

Section: Introductionmentioning

confidence: 99%

Pathological correlates of brain arterial calcifications

Shapiro

Goldman

Morgello

et al. 2019

Cardiovascular Pathology

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Background: In clinical practice, calcifications seen on CT studies within the large brain arteries are often referred as a surrogate marker for cholesterol-mediated atherosclerosis. However, limited data exists to support the association between calcification and atherosclerosis. In this study, we examined if intracranial arterial calcifications were associated with cholesterol-mediated intracranial large artery atherosclerosis (ILAA) within the arteries of the Circle of Willis in an autopsy based sample. Methods: We carried out a cross-sectional analysis of histopathological characteristics of brain large arteries obtained from autopsy cases. Brain large arteries were examined for evidences of calcifications, which were rated as macroscopic (coalescent) and microscopic (scattered). In addition to calcification, we also obtained measurement of the arterial wall and the presence of ILAA and non-atherosclerotic arterial fibrosis. We built hierarchical models adjusted for demographic and vascular risk factors to assess the relationship between calcification and ILAA. Results: In univariate analysis, the presence of any arterial calcifications was associated with cerebral infarcts (29% v. 14%, p<0.01). Multi-variate analysis revealed that among all calcifications, coalescent calcifications were not associated with ILAA. In contrast, scattered calcifications were associated with ILAA (p<0.001), decreased lumen diameter (−1.87 +/− 0.41 mm p≤0.001) and increased luminal stenosis (0.03 +/− 0.01% p≤0.006). These findings were independent of age, sex or other vascular risk factors. Conclusions: This study demonstrates that coalescent calcifications in brain large arteries, although associated with morbidity, are not synonymous with cholesterol driven ILAA. Understanding the precise pathological components of cerebrovascular disease, including non-atherosclerotic arterial calcifications, will help develop individualized therapies beyond amelioration of traditional risk factors such as hyperlipidemia.

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Are Arterial Calcifications a Marker of Remodeling in Vertebrobasilar Territory?

Abstract: Higher prevalence of calcifications in vertebrobasilar artery territory of patients with stroke is associated with advanced age, larger arterial area, and history of previous transient ischemic attack/stroke.

Cited by 11 publications

References 12 publications

Histology-Verified Intracranial Artery Calcification and Its Clinical Relevance With Cerebrovascular Disease

Histology-Verified Intracranial Artery Calcification and Its Clinical Relevance With Cerebrovascular Disease

Intracranial Vertebrobasilar Calcification in Patients with Ischemic Stroke Is a Predictor of Recurrent Stroke, Vascular Disease, and Death: A Case-Control Study

Pathological correlates of brain arterial calcifications

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