Prevalence and Outcomes of Symptomatic Intracranial Large Artery Stenoses and Occlusions in China

Abstract

Background and Purpose-We aimed to establish the prevalence, characteristics, and outcomes of intracranial atherosclerosis (ICAS) in China by a large, prospective, multicenter study. Methods-We evaluated 2864 consecutive patients who experienced an acute cerebral ischemia <7 days after symptom onset in 22 Chinese hospitals. All patients underwent magnetic resonance angiography, with measurement of diameter of the main intracranial arteries. ICAS was defined as ≥50% diameter reduction on magnetic resonance angiography. Results-The prevalence of ICAS was 46.6% (1335 patients, including 261 patients with coexisting extracranial carotid stenosis). Patients with ICAS had more severe stroke at admission and stayed longer in hospitals compared with those without intracranial stenosis (median National Institutes of Health Stroke Scale score, 3 versus 5; median length of stay, 14 versus 16 days; both P<0.0001). After 12 months, recurrent stroke occurred in 3.27% of patients with no stenosis, in 3.82% for those with 50% to 69% stenosis, in 5.16% for those with 70% to 99% stenosis, and in 7.27% for those with total occlusion. Cox proportional hazards regression analyses showed that the degree of arterial stenosis, age, family history of stroke, history of cerebral ischemia or heart disease, complete circle of Willis, and National Institutes of Health Stroke Scale score at admission were independent predictors for recurrent stroke at 1 year. The highest rate of recurrence was observed in patients with occlusion with the presence of ≥3 additional risk factors. Conclusions-ICAS is the most common vascular lesion in patients with cerebrovascular disease in China. Recurrent stroke rate in our study was lower compared with those of previous clinical trials but remains unacceptably high in a subgroup of patients with severe stenosis. (Stroke. 2014;45:663-669.)

Atherosclerosis in stroke‐related vascular beds and stroke risk: A 3‐D MR vessel wall imaging study

“…This hypothesis may explain the differences in plaque prevalence between intracranial and extracranial carotid arteries in the same population. The prevalence of intracranial artery severe stenosis in our data is lower than that of a multicenter study by Wang et al 25. (intracranial artery severe stenosis: 46.6%) in which patients with acute ischemic events (<7 days) were recruited.…”

Etiology of intracranial stenosis in young patients: a high-resolution magnetic resonance imaging study

“…Further analysis suggested that even in those ≤35 years old, eccentric stenosis was observed in as high as 2/3 of the patients. Taken together, our study suggests that atherosclerosis is the most common cause of intracranial stenosis in Chinese young patients, similar to the old (20,21). On the other hand, the patients aged 36 to 45 years old had more traditional vascular risk factors and eccentric stenosis than those ≤35 years old, supporting that the rising incidence of traditional vascular risk factors have effects on intracranial artery pathophysiology (17,21,22).…”

Site and Rate of Occlusive Disease in Cervicocerebral Arteries: A CT Angiography Study of 2209 Patients with Acute Ischemic Stroke

“…A higher rate of intracranial stenosis has been described in Asian patients with ischemic stroke. 17 The 40% concurrent extracranial (tandem) pathology observed in patients with a symptomatic intracranial abnormality has practical implications because it may complicate endovascular access. This situation seems to be particularly frequent in the anterior circulation (odds ratio of 5.0 for anterior-versus-posterior tandem lesions in our population).…”