Carotid artery calcification and ischemic stroke： a retrospective case series study

Abstract

Objective To investigate the relationship between carotid artery calcification and ischemic stroke.Methods The demographic data,vascular risk factors and clinical features of patients with acute ischemic stroke and non-acute stroke patients admitted in the same period were collected retrospectively.All the patients received 64-slice spiral CT examination,and the scan data were transmitted to a GE workstation.A smart score software was used to evaluate carotid artery calcification.Multivariate logistic regression analysis was used to identify the independent risk factors for ischemic stroke.Receiver operator characteristic （ROC） curve was used to analyze and determine the predictive value of carotid artery calcification in acute ischemic stroke.Results A total of 86 patients with acute ischemic stroke and 89 with non-acute stroke （control group） were enrolled.In addition to the previous stroke history,there were no significant differences in age,gender,and vascular risk factors between the ischemic stroke group and the control group.The calcium score （338.57 ± 77.35 vs.147.79 ± 64.52; t =4.065,P =0.045）,total calcified volume （372.22 ± 78.73 mm3 vs.197.27 ±61.12 mm3; t =4.740,P =0.031）,and calcification quality （70.33 ± 13.83 mg vs.32.44 ± 12.27 mg; t =6.673,P =0.011） of the ischemic stroke group were significantly higher than those of the control group.In patients with ischemic stroke,there were no significant differences in the carotid artery calcification score （335.50 ± 85.95 vs.312.73 ± 90.61; t =0.052,P =0.820）,total calcified volume （357.91 ± 88.93 mm3 vs.311.71 ± 81.43 mm3; t=0.071,P=0.791）,and calcium quality （59.68± 17.36 mg vs.51.29 ± 18.69 mg; t =0.071,P =0.791） between the symptomatic sides and non-symptomatic sides.Multivariate logistic regression analysis showed that the carotid artery calcification score （odds ratio [OR] 4.963,95% confidence interval [CI] 5.932-18.994; P=0.019）,total calcified volume （OR 5.967,95% CI 3.940-14.993; P =0.015）,and calcium quality （OR 6.815,95% CI 4.703-21.946; P =0.007） were the independent risk factors for ischemic stroke.The ROC curve analysis of carotid artery calcification score showed that when it was 231.25,it had a predictive value for acute ischemic stroke.The sensitivity was 85.4%,specificity was 89.9%,positive predictive value was 87.1%,and negative predictive value was 89.1%.The area under the ROC curve was 0.891 （95% CI 0.808-0.913; P =0.027）.Conclusions Carotid artery calcification is one of the independent risk factors for ischemic stroke.Carotid artery calcification score has some predictive value for acute ischemic stroke. Key words: Stroke; Brain Ischemia; Carotid Artery Diseases; Calcinosis; Tomography,X-Ray Computed; Risk Factors