Intracranial Carotid Artery Calcification and Effect of Endovascular Stroke Treatment

Compagne, Kars C.J.; Clephas, Pascal R.D.; Majoie, Charles B. L. M.; Roos, Yvo B.W.E.M.; Berkhemer, Olvert A.; Oostenbrugge, Robert J. van; Zwam, Wim H. van; Es, Adriaan C.G.M. van; Dippel, Diederik W.J.; Lugt, Aad van der; Bos, Daniel

doi:10.1161/strokeaha.118.022400

Cited by 32 publications

(47 citation statements)

References 34 publications

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“…Information on cardiovascular risk-and prognostic factors was obtained at admission to the hospital as previously described 14 . Intracranial carotid artery calcifications (ICAC) were manually segmented on NCCT scans and subsequently used to compute ICAC volumes 3 . ICAC pattern was divided into either intimal or medial calcification pattern using a visual scoring method 3,16 .…”

Section: Assessment Of Covariablesmentioning

confidence: 99%

“…Intracranial carotid artery calcifications (ICAC) were manually segmented on NCCT scans and subsequently used to compute ICAC volumes 3 . ICAC pattern was divided into either intimal or medial calcification pattern using a visual scoring method 3,16 . ASPECTS was graded on…”

Section: Assessment Of Covariablesmentioning

confidence: 99%

“…Imaging characteristics at baseline such as collateral status 2 , intracranial carotid artery calcification pattern (ICAC) 3 , and in the late time window, the Alberta Stroke Program Early CT Score (ASPECTS) 4 have been shown to influence the effectiveness of EVT in terms of post-procedural functional outcome.…”

Section: Introductionmentioning

confidence: 99%

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Association of White Matter Lesions and Outcome After Endovascular Stroke Treatment

Luijten¹,

Bos²,

Compagne³

et al. 2021

Neurology

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ObjectiveTo investigate the association between white matter lesions (WML) and functional outcome in patients with acute ischemic stroke (AIS) and the modification of the effect of endovascular treatment (EVT) by WML.MethodsWe used data from the Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN) trial and assessed severity of WML on baseline non-contrast CT imaging (NCCT; n = 473) according to the Van Swieten Scale. Post-stroke functional outcome was assessed with the modified Rankin Scale (mRS). We investigated the association of WML with functional outcome using ordinal logistic regression models adjusted for age, sex, and other relevant cardiovascular and prognostic risk factors. In addition, an interaction term between treatment allocation and WML severity was used to assess treatment effect modification by WML.ResultsWe found an independent negative association between more severe WML and functional outcome (acOR 0.77 [95% CI 0.66–0.90]). Patients with absent to moderate WML had similar benefit of EVT on functional outcome (acOR 1.93 [95% CI 1.31–2.84]) as patients with severe WML (acOR 1.95 [95% CI 0.90–4.20]). No treatment effect modification of WML was found (p for interaction = 0.85).ConclusionsWe found that more severe WML predict poor functional outcome after acute ischemic stroke, but do not modify effect of EVT.Classification of evidencePrognostic accuracy. This study provides Class II evidence that for patients with AIS, the presence of WML on baseline NCCT is associated with worse functional outcomes.

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Section: Assessment Of Covariablesmentioning

confidence: 99%

Section: Assessment Of Covariablesmentioning

confidence: 99%

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Association of White Matter Lesions and Outcome After Endovascular Stroke Treatment

Luijten¹,

Bos²,

Compagne³

et al. 2021

Neurology

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“…These patterns can be distinguished on NECT [10]. The secondary analysis from the randomized-controlled MR-CLEAN study showed that patients with medial calcification pattern when compared to patients with intimal calcification pattern benefit from endovascular intervention [27]. Although we did not assess calcifications patterns according to score proposed by Kockelkoren et al, and we were looking into vertebrobasilar arteries, we included morphological types of calcifications (crescent and/or circular).…”

Section: Discussionmentioning

confidence: 99%

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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“…In contrast, another study concluded that extensive ICAC did not have an impact on reperfusion or clinical outcomes in AIS patients undergoing endovascular therapy (14). In addition, Compagne et al (32) recently demonstrated that ICAC volume was not associated with functional outcomes after endovascular thrombectomy for AIS, but they found that medial or intimal calcification patterns influenced the effect (32). For the factors influencing endovascular intervention treatment to cover many aspects, including mechanical devices, operation technique, intervention time and periprocedural complications, it requires more comprehensive consideration.…”

Section: Discussionmentioning

confidence: 99%

Lack of Correlation Between Intracranial Carotid Artery Modified Woodcock Calcification Score and Prognosis of Patients With Acute Ischemic Stroke After Intravenous Thrombolysis

Zhao

et al. 2019

Front. Neurol.

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There have been few studies about the association between intracranial carotid artery calcification (ICAC) and acute ischemic stroke (AIS) prognosis after intravenous thrombolysis (IVT). We aimed to analyze the association between ICAC and prognosis (including symptomatic intracranial hemorrhage (sICH), functional outcome and death) of AIS patients treated with IVT. In this retrospective study, we consecutively included 232 AIS patients treated with IVT between April 2012 and December 2018. ICAC was evaluated using the modified Woodcock calcification visual score on non-enhanced cranial computed tomography scans. Poor functional outcome was defined as a modified Rankin Scale score > 2 at 3 months. We found that the modified Woodcock calcification score was associated with ICH, poor outcome, and death in univariable analyses on the symptomatic side and/or bilaterally. However, after adjustment for other different covariates, the results showed no significant difference. We documented that the presence and severity of ICAC did not significantly modify the beneficial effects of rtPA treatment in AIS.

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Intracranial Carotid Artery Calcification and Effect of Endovascular Stroke Treatment

Abstract: Supplemental Digital Content is available in the text.

Cited by 32 publications

References 34 publications

Association of White Matter Lesions and Outcome After Endovascular Stroke Treatment

Association of White Matter Lesions and Outcome After Endovascular Stroke Treatment

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

Lack of Correlation Between Intracranial Carotid Artery Modified Woodcock Calcification Score and Prognosis of Patients With Acute Ischemic Stroke After Intravenous Thrombolysis

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