Abstract
Background and PurposeIntracranial arterial calcification (IAC) may be present in the intimal or medial arterial layer. This study aimed to elucidate the link between the calcification and atherosclerotic disease in the intracranial vasculature.MethodsConsecutive patients with acute ischemic stroke were included. Bilateral intracranial segment of the internal carotid artery, M1 segment of the middle cerebral artery, intracranial segment of the vertebral artery, and the basilar artery were visualized by the multi-detector computed tomography (CT) and vessel-wall magnetic resonance imaging (vwMRI) within 14 days after stroke onset. IAC was into the intimal or medial pattern. Subsequently, on the vwMRI, we assessed the luminal stenosis, eccentricity, plaque burden, and intraplaque hemorrhage (IPH) as markers of atherosclerosis at each IAC site.ResultsAmong 69 patients with stroke, IAC was identified in 35% of (161/483) artery segments, of which 61.5% were predominantly intimal calcification and 38.5% were predominantly medial calcification. About 79.8% of intimal calcifications and 64.5% of medial calcifications co-existed with atherosclerotic plaques. Intimal calcification was associated with luminal stenosis (p = 0.003) caused by atherosclerotic lesions. Compared with the medial IAC, intimal IAC was more often accompanied by eccentric plaques (p = 0.02), larger plaque burden (p = 0.001), and IPH (p = 0.001).ConclusionOur multimodal imaging-based comparison study on intracranial arteriosclerosis demonstrated that intimal IAC, compared with medial IAC, was more often accompanied by the luminal stenosis, larger plaque burden, eccentricity, and IPH, providing strong evidence for clinical evaluation on the mechanism, risk, and prognosis of ischemic stroke.
Highlights
Intracranial arterial calcification (IAC) is commonly seen in major cerebral arteries [1,2,3] and established as an independent risk factor for stroke [4]
Patients who underwent computed tomography (CT), routine magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and vessel-wall magnetic resonance imaging within 14 days after the onset of ischemic stroke or transient ischemic attack (TIA) from 2014 to 2018 at the Prince of Wales Hospital, Hong Kong were included in this study
We found that medial calcifications were prevalently distributed in the intracranial internal carotid artery (ICA) while the distribution of intimal calcifications was more equal
Summary
Intracranial arterial calcification (IAC) is commonly seen in major cerebral arteries [1,2,3] and established as an independent risk factor for stroke [4]. In previous studies, grading by extent and thickness qualitatively [5] and calculating volume with specific software quantitatively [6] were the most frequently applied evaluation methods on IAC. Both methods lack consideration about the inherent difference between IACs in separate layers of vessel wall, which may act as a potential cause to contradictory findings [3, 7]. Intracranial arterial calcification mainly involves the intimal and medial layer, which could vary in both histopathological feature and imaging [8]. This study aimed to elucidate the link between the calcification and atherosclerotic disease in the intracranial vasculature
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