Assessment of intracranial and extracranial atherosclerosis in patients presenting with acute ischaemic stroke

Abstract

Background: Few Indian studies are available which have examined the risk factors and extracranial and intracranial vascular observations in patients with stroke.Methods: We prospectively studied the burden of intracranial atherosclerosis (ICAS) and extracranial atherosclerosis (ECAS) in patients (n = 300) with acute ischaemic stroke and study the vascular disease to the outcome of the patients.Results: Their mean age was 57.8 ± 14.2 years; there were 183 (61%) males. The frequency of risk factors were hypertension (73%), diabetes mellitus (46%), tobacco smoking (34%), dyslipidaemia (39.3%), alcoholism (27%), previous stroke (21%), chronic kidney disease (CKD) (9%) and hyperhomocystinaemia (15%). Multiple and single territory infarction was evident in 103 (34.3%) and 197 (65.7%), respectively. Both ICAS and ECAS were evident in 117 (39%), whereas 111 (37%) had ICAS and 36 (12%) had ECAS. On univariate analysis, the presence of CKD (P = 0.01), previous stroke (P = 0.02), ICAS and combined ICAS plus ECAS were associated with unfavourable outcome (P = 0.0001). On multivariable analysis, age >58 years (odds ratio [OR] 1.04, 95% confidence intervals [CI] 0.71–0.89, P < 0.0001), female gender (OR 0.6, 95% CI 0.41–0.87, P = 0.008), National Institutes of Health Stroke Scale score >18 (OR 0.75, 95% CI (0.71–0.80, P < 0.0001) were associated poor functional outcome.Conclusions: ICAS was more common than ECAS. ICAS and combined ICAS plus ECAS were associated with unfavourable outcome.