Abstract
BackgroundLarge-artery intracranial atherosclerosis may be the most frequent cause of ischemic stroke worldwide. Traditional approaches have attempted to target the disease when it is already symptomatic. However, early detection of intracranial atherosclerosis may allow therapeutic intervention while the disease is still asymptomatic. The prevalence and natural history of asymptomatic intracranial atherosclerosis in Caucasians remain unclear. The aims of the Barcelona-ASymptomatic Intracranial Atherosclerosis (ASIA) study are (1) to determine the prevalence of ASIA in a moderate-high vascular risk population, (2) to study its prognostic impact on the risk of suffering future major ischemic events, and (3) to identify predictors of the development, progression and clinical expression of this condition.Methods/DesignCross-over and cohort, population-based study. A randomly selected representative sample of 1,503 subjects with a mild-moderate-high vascular risk (as defined by a REGICOR score ≥ 5%) and with neither a history of cerebrovascular nor ischemic heart disease will be studied. At baseline, all individuals will undergo extracranial and transcranial Color-Coded Duplex (TCCD) ultrasound examinations to detect presence and severity of extra and intracranial atherosclerosis. Intracranial stenoses will be assessed by magnetic resonance angiography (MRA). Clinical and demographic variables will be recorded and blood samples will be drawn to investigate clinical, biological and genetic factors associated with the presence of ASIA. A long-term clinical and sonographic follow-up will be conducted thereafter to identify predictors of disease progression and of incident vascular events.DiscussionThe Barcelona-ASIA is a population-based study aiming to evaluate the prevalence and clinical importance of asymptomatic intracranial large-artery atherosclerosis in Caucasians. The ASIA project may provide a unique scientific resource to better understand the dynamics of intracranial atherosclerosis from its early stages and to identify new potential therapeutic targets for this condition.
Highlights
Large-artery intracranial atherosclerosis may be the most frequent cause of ischemic stroke worldwide
Despite the extended use of non invasive diagnostic techniques as transcranial Doppler (TCD), transcranial color-codedduplex (TCCD), magnetic resonance angiography (MRA) or computed tomography angiography intracranial atherosclerosis disease (ICAD) is an infradiagnosed and understudied disease when compared to extracranial atherosclerosis
ICAD is the origin of 5-10% of strokes in Caucasians [36,37] and up to 50% in Asians [38,39]
Summary
Despite of its relevant impact on public health and the development of new non-invasive diagnostic tests, intracranial atherosclerosis is still an understudied pathology. The only population studies to determine its prevalence in stroke-free individuals were developed in Asians without prospective follow-up to assess the risk of vascular events (21-25) These studies have some limitations as they evaluated intracranial stenosis only with transcranial Doppler, they did not use contrast agents and some of them only evaluated middle cerebral artery. Our study is the first to evaluate the prevalence of asymptomatic intracranial atherosclerosis in Caucasians As it is a cohort study we will investigate the ASIA prognosis impact, in the appearance of cerebral events and in coronary and peripheral artery disease, and in the development of vascular cognitive impairment. Neuropsychological studies are supported by the Juan de la Cierva research program of the Spanish Health and Social Policy Ministry [SEJ2006-15399/PSIC]
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