Prevalence and Clinico-Radiologic Spectrum of Intracranial Atherosclerotic Disease-Related Stroke

Abstract

Background: Intracranial atherosclerotic disease (ICAD) is an important etiologic subtype of acute ischemic stroke (AIS). However, little direct evidence is available regarding ICAD-related stroke in Saudi Arabia (SA). This study aimed to identify the prevalence and describe the clinico-radiological spectrum of ICAD-related AIS in a SA cohort.Methods: This was a hospital-based retrospective study enrolling patients with ICAD-related AIS between 2017 and 2020. The electronic charts were reviewed. The mechanisms of stroke were identified as artery-to-artery embolization (AAE), in situ thrombotic occlusion, hypoperfusion, or perforator branch occlusion. Pearson's χ 2 test was performed to calculate the P values to establish the statistical significance of factors that could correlate with the mechanisms of stroke and functional outcome.Results: ICAD was found in 133 of AIS comprising 26% of total. Data from all patients were reviewed. Left ICA (25%) was the most frequently affected vessel. Territorial pattern (63.9%) was the most common infarct pattern, and AAE (44.3%) was the most common underlying mechanism. Perforator branch occlusion was more prevalent in women than in men. Malignant and hemorrhagic transformation (P = 0.00) were more prevalent in the AAE group. Left-sided vascular involvement was statistically associated with unfavorable outcomes than the right (P = 0.019). Conclusions:The prevalence of ICAD in our cohort from Western Asia did not differ from that in Southern Asia. ICA involvement was observed more frequently than previously reported. Further research from SA is required to better understand ICAD-related strokes in this region.

Association between glycated hemoglobin and functional outcomes in patients with intracranial large artery atherosclerotic disease-related acute ischemic stroke: identifying the magic number

“…Data were collected by reviewing the electronic medical charts of patients from the hospital data bank. The data collection method and definitions were largely the same as described previously ( 2 ). The patient inclusion flowchart is shown in Figure 1 .…”

“…Infarct patterns were defined based on neuroimaging findings as follows: territorial, watershed/border zone, and perforator/lacunar. Underlying mechanisms were categorized as follows: artery-to-artery embolism, thrombotic occlusion, hemodynamic impairment/hypoperfusion, and perforator/penetrating branch occlusion in continuation of parent stenosed vessel, as mentioned previously ( 2 ).…”

“…Intracranial large artery atherosclerotic disease (ICLAD) is a subtype of the large artery atherosclerosis (LAA) etiology affecting the intracranial circulation, which is considered the most common cause of stroke worldwide ( 1 ). ICLAD accounts for 20–50% of cases of acute ischemic stroke (AIS) in Asian countries, including Saudi Arabia (SA) ( 1 , 2 ). The relationship between glycated hemoglobin (HbA1c) levels and atherosclerotic cardiovascular diseases (CVDs), including cerebrovascular disease, is well established, and HbA1c ≥7% is associated with increased risks of CVD morbidity and mortality, including stroke ( 3 ).…”