Prevalence of asymptomatic intracranial atherosclerosis in high-risk patients

Wong, Ka Sing; Ng, P. W.; Tang, Aiyu; Liu, R.; Yeung, V. T. F.; Tomlinson, Benjamin

doi:10.1212/01.wnl.0000264427.09191.89

Cited by 134 publications

(109 citation statements)

References 8 publications

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“…ICS is the most common vascular lesion in Asians with ischemic stroke 2, 3, 4. The estimated prevalence of middle cerebral artery stenosis among asymptomatic Asian patients ranges from 7.2% to 29.6%, while Asian patients with ischemic stroke have a higher ICS incidence of 33% to 84% 4, 19. Further, concurrent atherosclerosis of intracranial and extracranial vessels is not uncommon in Asian populations13, 20, 21, 22; in fact, ≈20% to 50% of patients with ECS are reported to also have ICS 22, 23, 24.…”

Section: Discussionmentioning

confidence: 99%

Risk Factor Stratification for Intracranial Stenosis in Taiwanese Patients With Cervicocerebral Stenosis

Sung

Lee

Tsai

et al. 2015

JAHA

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BackgroundIntracranial stenosis (ICS) is a major determinant of ischemic stroke in Asians. We determined the clinical significance of different risk factors and the role of ICS in Taiwanese patients with varied distributions of cervicocerebral stenosis.Methods and ResultsPresence of extracranial carotid stenosis (ECS, ≥70%) and ICS (>50%) was examined in 13 539 patients using ultrasonography and magnetic resonance angiography, respectively. Seven hundred thirty‐three patients with non‐ECS/ICS (n=372), isolated ICS (n=112), isolated ECS (n=121), or combined ECS/ICS (CEIS, n=128) were selected. Prevalence of ischemic stroke in each group was compared, and risk factors for stenosis were determined. The area under the receiver operating characteristic curve for each risk factor was calculated. Prevalence of ischemic stroke was highest in patients with CEIS (odds ratio 15.86; P<0.001), followed in decreasing order by those with isolated ICS (odds ratio 7.16; P<0.001), isolated ECS (odds ratio 1.77; P=0.011), and non‐ECS/ICS. Multivariate logistic regression analysis revealed that hypertension, coronary artery disease, and smoking were risk factors for isolated ECS; hypertension, diabetes mellitus, coronary artery disease, and smoking were risk factors for isolated ICS; and diabetes mellitus, coronary artery disease, and smoking were risk factors for CEIS. Smoking, diabetes mellitus, and coronary artery disease were the greatest contributors to CEIS, isolated ICS, and isolated ECS, respectively.ConclusionsCEIS was associated with higher odds of ischemic stroke compared with isolated ICS and isolated ECS. Smoking and diabetes mellitus, major determinants of CEIS and isolated ICS, should be targeted in therapeutic strategies to reduce the risk of ischemic stroke.

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Section: Discussionmentioning

confidence: 99%

Risk Factor Stratification for Intracranial Stenosis in Taiwanese Patients With Cervicocerebral Stenosis

Sung

Lee

Tsai

et al. 2015

JAHA

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“…In previous studies, it has been determined that DM was associated with ICS (3,(13)(14)(15)(16)(17)19,21). Tsivgoulis et al found that DM was the strongest predictive factor of ICS (14).…”

Section: Risk Factors Of Icsmentioning

confidence: 99%

Prevalence and prognosis of intracranial stenosis in acute ischemic stroke;a single center registry from Turkey

Sorgun¹,

Yılmaz²,

Ulukan³

et al. 2017

Turk J Med Sci

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The medical records of 619 consecutive patients who were admitted with acute ischemic stroke from January 2012 to November 2014 were retrospectively evaluated. Approval was obtained from the research ethics committee in advance of the study. ICS was defined as any intracranial stenosis >50% on cerebrovascular imaging such as computerized tomography angiography, magnetic resonance angiography, or digital subtraction angiography performed within 1 week of ischemic stroke. The degree of stenosis was calculated according to the WASID method (22). Clot was defined if there was an angiographic evidence of abrupt cut-off or there was vascular imaging evidence that the occluded intracranial artery has been completely recanalized. The patients were divided into two groups: group 1 included patients with ICS and group 2 included patients without ICS.Patient demographics and medical risk factors, including history of hypertension, diabetes, hyperlipidemia, atrial fibrillation, congestive heart failure, coronary artery disease, previous transient ischemic attack, previous Background/aim: Intracranial stenosis (ICS) is identified in 2.2%-70.4% of patients with ischemic stroke and transient ischemic attack. This study aimed to determine the prevalence of ICS in a single center registry from Turkey. Materials and methods:We reviewed the charts of 619 patients with acute ischemic stroke. ICS was defined as any ICS > 50% on cerebrovascular imaging. The demographic data, risk factors, NIHSS scores and C reactive protein level at admission, mortality in hospital, recurrent stroke, and mRS in the follow-up period were recorded.Results: A total of 72 (11.6%) patients with ICS (45 males (62.5%); mean age 68.3 ± 12.6 years) were included. Sixty-seven patients (10.8%) had symptomatic ICS and 44 patients (7.1%) had ICS without extracranial stenosis. Diabetes mellitus (DM) was significantly higher in the ICS group compared to the others (P = 0.017). Disability was significantly better in patients with ICS compared to the others (P < 0.001). On logistic regression analysis, DM and follow up mRS were significantly associated with ICS (P < 0.05). Conclusion:ICS was seen in 11.6% of acute ischemic stroke cases in our registry. DM appears to be the major risk factor for ICS. Disability was better in patients with ICS. Ethnicity could be a factor causing better disability.

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“…Warfarin versus Aspirin in Symptomatic Intracranial disease (WASID) trial reported presence of 27% asymptomatic disease in patients who also had symptomatic stenosis (Nahab et al, 2008). Studies of healthy Japanese and Korean populations report asymptomatic disease in 3-3.5% (Park et al, Wong et al, 2007). There is a growing need to identify the asymptomatic entity as the process of atherosclerosis can potentially be stalled by timely risk factor management.…”

Section: Epidemiologymentioning

confidence: 99%

Neuroimaging - Clinical Applications

Bright¹

2012

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Prevalence of asymptomatic intracranial atherosclerosis in high-risk patients

Cited by 134 publications

References 8 publications

Risk Factor Stratification for Intracranial Stenosis in Taiwanese Patients With Cervicocerebral Stenosis

Risk Factor Stratification for Intracranial Stenosis in Taiwanese Patients With Cervicocerebral Stenosis

Prevalence and prognosis of intracranial stenosis in acute ischemic stroke;a single center registry from Turkey

Neuroimaging - Clinical Applications

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