Abstract
BACKGROUND: Cerebral arterial calcification has been reported to be associated with lacunar infarction and white matter hyperintensities. The aim of the present study was to determine the association between arterial calcification and cerebral microbleed (CMB) which is a small hemorrhagic lesion in the brain and is known to be associated with small vessel disease (SVD). METHODS: We identified 834 consecutive patients with acute ischemic stroke who visited a tertiary university hospital within 7 days of symptom onset and underwent both CT angiography and brain MR imaging. Calcifications in the intracranial internal carotid artery (ICA) were graded on CT angiography. CMBs were counted relative to their location on susceptibility-weighted imaging. The association between ICA calcification and CMB was tested using logistic regression analysis. RESULTS: The patients ranged in age from 26 to 111 years (67 ± 12.7 years, mean ± standard deviation). ICA calcification and CMB were found in 660 patients (79.1%) and 335 patients (40.2%), respectively. On multivariable analysis, ICA calcification was associated with CMB of any location (odds ratio (OR) 1.76, 95% confidence interval (CI) 1.31 - 2.36 for mild calcification; OR 2.86, 95% CI 2.01 - 4.08 for severe calcification, respectively). More robust association was found between calcification and CMB in the basal ganglia, thalamus, or brainstem (odds ratio (OR) 1.76, 95% confidence interval (CI) 1.27 - 2.44 for mild calcification; OR 3.51, 95% CI 2.39 - 5.14 for severe calcification, respectively). However, ICA calcification was not associated with CMB strictly located in the lobar area. CONCLUSIONS: ICA calcification is an independent predictor for deep CMB but not for a strictly lobar CMB. Our findings add evidence to the hypothesis that cerebral arterial calcification is associated with SVD and might contribute to the elucidation of the pathogenesis of SVD.
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