Abstract T P171: Clinical and Imaging Features Associated with Intracranial Internal Carotid Artery Calcifications in Patients with Ischemic Stroke

Abstract

Background: Intracranial internal carotid artery calcifications (ICAC), a radiologic feature frequently detected on imaging studies, have been shown to be associated with future stroke risk in population-based studies. The clinical significance of this observation among patients with ischemic stroke is, on the other hand, less clear. In this study we sought to identify features associated with ICAC burden in a consecutive series of ischemic stroke patients. Methods: The burden of ICAC was determined separately on non-contrast CT and CT-angiography by semi-quantitative scoring algorithms. The distribution of vascular risk factors, etiologic stroke subtype and calcification burden in other craniocervical arteries were assessed among patients with no ICAC, mild-moderate ICAC and severe ICAC. Results: Of the 319 patients included into the study, 28% had no ICAC, 35% had mild-moderate ICAC and 37% hade severe ICAC on CT-angiography source images. The corresponding figures were 22%, 38% and 41%, respectively, when the ratings were performed on non-contrast CT. Overall non-contrast CT and CT-angiography based ratings were highly correlated (r=0.90, p<0.001). ICAC burden was significantly associated with older age, history of hypertension, diabetes mellitus, coronary artery disease and atrial fibrillation, higher prevalence of large artery atherosclerosis and cardio-aortic embolism as the underlying stroke subtype and presence of calcifications in other craniocervical vessels. Multivariate analyses revealed age, history of diabetes mellitus and coronary artery disease, together with a stroke etiology of large artery atherosclerosis, as factors independently associated with ICAC burden. Conclusion: ICAC burden as determined either by non-contrast CT or CT-angiography reflects a continuum of atherosclerotic disease involving the carotid arteries together with other craniocervical vascular beds. ICAC is significantly associated with large artery atherosclerosis related stroke and might thereby guide the clinician for therapeutic management and etiologic work-up during the acute period.