Intracranial Artery Stenosis Group Research Articles

Exploring the risk factors for ischemic cerebrovascular disease in systemic lupus erythematosus: A single-center case-control study.

ObjectivesIschemic cerebrovascular disease (ICVD) is one of the most common and severe complications in systemic lupus erythematosus (SLE). We aim to explore the risk factors for ICVD in SLE and to assess their associated clinical characteristics.MethodsIn this study, 44 lupus patients with ICVD (ICVD-SLE) and 80 age- and sex-matched lupus patients without ICVD (non-ICVD-SLE) who were hospitalized in our center between 2014 and 2021 were enrolled. A comprehensive set of clinical and socio-demographic data was recorded. In the ICVD-SLE group, the modified Rankin score (mRS) at 90 days after the occurrence of ICVD, the brain MRI, and arterial ultrasonography findings were collected. Group comparisons were made with continuous variables using an independent t-test or the Mann–Whitney test, and with categorical variables using the chi-square test or Fisher exact test. Multivariate logistic regression analysis was performed to identify the risk factors for ICVD in SLE. Patients with ICVD-SLE were divided into three subgroups according to the gradations of intracranial arterial stenosis (ICAS). The subgroup comparisons were performed by one-way ANOVA test or Kruskal–Wallis test.ResultsOf the 44 patients with ICVD, 45% had a large-vessel ischemic stroke, 50% had a symptomatic lacunar stroke, and 9% had a transient ischemic attack. 2 (4.5%) had both large-vessel ischemic stroke and symptomatic lacunar stroke. Multivariate logistic regression analysis showed that cutaneous vasculitis (OR=7.36, 95% CI=2.11–25.65), anticardiolipin antibody (aCL) (OR=4.38, 95% CI=1.435–13.350), and lupus anticoagulant (LA) (OR=7.543,95% CI=1.789–31.808) were the risk factors, and hydroxychloroquine (HCQ) therapy (OR=0.198, 95% CI=0.078–0.502) was the protective factor, after controlling for confounders. During the analysis of the subgroups, no significant difference was observed between the patients in the group without internal carotid arterial occlusion (ICAS) and those with severe ICAS except for diagnostic delay. However, patients in the moderate ICAS group were older when SLE occurred (P<0.01), had a longer diagnostic delay (P<0.01), a lower percentage of hypocomplementemia (P=0.05) and steroids and HCQ therapy (P=0.01, P=0.05, respectively), a trend toward lower mRS score, but a higher incidence of carotid atherosclerotic plaque (P<0.01), when compared with the other two subgroups.ConclusionCutaneous vasculitis and antiphospholipid antibodies (aPLs) are associated with an increased risk of ICVD, while HCQ therapy may provide protection against ICVD in SLE. The ICVD in younger lupus patients is associated with complement-mediated inflammation and poorer outcome, and require immunosuppressive therapy, whereas the ICVD in elderly patients are characterized by moderate ICAS and carotid atherosclerotic plaques.

Elevated Lipoprotein-Associated Phospholipase A2 Is Associated With Intracranial Atherosclerosis.

BackgroundLipoprotein-associated phospholipase A2 (Lp-PLA2) is an inflammatory factor in the pathogenesis of atherosclerotic plaque and is associated with an increased risk of ischemic stroke. Whether Lp-PLA2 is associated with stenosis subtypes in acute ischemic stroke (AIS) has not been investigated.MethodsA total of 126 eligible AIS patients were divided into four groups: (1) no cerebral artery stenosis (NCS); (2) intracranial artery stenosis (ICAS); (3) extracranial artery stenosis (ECAS); and (4) combined intracranial and extracranial artery stenosis (IECS). Associations between serum Lp-PLA2 levels and the stenosis subtypes were assessed.ResultsThe ICAS group had a lower frequency of dyslipidemia as compared to the NCS group and the IECS group (35.3% vs. 70% vs. 71.8%, respectively, p = 0.001) and was more likely to be symptomatic than the ECAS group (76.5% vs. 43.8%, respectively, p = 0.014). Lp-PLA2 levels in the ICAS group were 112.2 ± 66.8 μg/L which are, higher than those in the NCS, ECAS, and IECS groups (81.7 ± 38.5, 106.1 ± 57.8, 89.3 ± 52.2 μg/L, respectively, p = 0.025). In the third and fourth quartiles of Lp-PLA2 levels, stenosis had occurred more frequently in the ICAS group than in the other three groups (third Q: 50.0% vs. 3.1% vs. 28.1% vs. 18.8%, p = 0.002; fourth Q: 48.4% vs. 16.1% vs. 25.8% vs. 9.7%, p = 0.014). Lp-PLA2 levels were higher in patients with more or severe stenosis in the ICAS group.ConclusionsElevated Lp-PLA2 levels were differentially associated with increased risk in AIS patients with ICAS compared to those with ECAS or no stenosis. Lp-PLA2 may be a promising biomarker and potential therapeutic target for ICAS.

Association of antinuclear antibodies with the risk of intracranial arterial stenosis.

The prevalence of intracranial arterial stenosis (IAS) as well as antinuclear antibody (ANA) positivity was found to be higher in Asians than that in the Western population. To investigate the relation of ANAs with IAS in patients with acute ischemic cerebrovascular disease, we enrolled 2492 patients with acute ischemic stroke or transient ischemic attack into the study. All the patients were categorized into 3 groups according to the IAS burden. Multinomial logistic regression analyses were used in statistical analysis. The positive rate of ANAs in the IAS ≥ 2 group was higher than that in the single IAS group and the no IAS group (p<0.001). The adjusted odds ratio (OR) for IAS ≥ 2 in ANAs-positive patients was 3.737 (95%CI=2.676-5.220, p<0.001) compared with the ANAs-negative patients. ANAs were associated with multiple IAS rather than single IAS in both male and female subgroups. Besides, ANAs were significantly associated with single and multiple IAS in individuals ≤ 60 years. However, ANAs were only associated with two or more IAS in two age groups (between 61 to 75 years and >75 years old). In summary, ANAs are associated with IAS in patients with acute ischemic cerebrovascular disease.

Lp-PLA2 and dual antiplatelet agents in intracranial arterial stenosis.

To evaluate the interaction effect of lipoprotein-associated phospholipase A2 (Lp-PLA2) activity on the efficacy and safety of dual/single antiplatelet therapy in patients with and without intracranial arterial stenosis (ICAS) by the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events trial. Patients with both MRI analysis and Lp-PLA2 testing results were included in the current subanalysis. The interaction of Lp-PLA2 activity with the effects of dual and single antiplatelet therapy were analyzed through Cox proportional hazards regressions model. Among the 797 patients, the mean age was 63.1 ± 10.8 years, 518 (65%) were men, 356 (44.7%) had ICAS, and 441 (55.3%) did not. There were significantly more patients with elevated Lp-PLA2 activity in the ICAS group than in the non-ICAS group (43.8% vs 35.4%, p = 0.02). There was significant interaction between Lp-PLA2 activity levels and the 2 antiplatelet therapies for prevention of stroke recurrences and combined vascular events even after adjustment for confounding factors exclusively for patients with ICAS (p = 0.017, 0.017, respectively), but not for those without (p = 0.332, 0.674, respectively). Compared with aspirin alone, dual antiplatelet therapy significantly reduced the risk of stroke recurrences and combined vascular events (adjusted hazard ratio 0.33 [0.12-0.89], p = 0.028; 0.33 [0.12-0.89], p = 0.028, respectively) for patients with ICAS and nonelevated Lp-PLA2 activity. Presence of both ICAS and nonelevated Lp-PLA2 activity may predict better response to dual antiplatelet therapy in prevention of recurrent strokes and combined vascular events for patients with minor stroke or high-risk TIA. NCT00979589.

Chronic Kidney Disease is Associated with Intracranial Artery Stenosis Distribution in the Middle-Aged and Elderly Population.

Aims: To investigate the association of chronic kidney disease (CKD) and intracranial artery stenosis (ICAS), as well as its effects on ICAS distribution in the middle-aged and elderly population.Methods: Data from the China Hypertension Survey in Beijing was analyzed. Estimated glomerular filtration rate (eGFR) was used to evaluate CKD, and ICAS was assessed by transcranial doppler. Clinical and biochemical variables were compared between the ICAS group and the non-ICAS group, as well as in different vascular distribution groups. Univariable and multivariable logistic regression analyses were introduced to demonstrate the association between CKD and ICAS.Results: A total of 3678 subjects were included in this study, with a mean age of 62 years old. Of which, 19.2% presented with decreased eGFR (eGFR < 60 ml/min/1.73 m2) and 17.4% for ICAS. The percentage of anterior circulation ICAS was 3.5 times than that of posterior circulation (10.9% vs. 3.1%). In multivariable regression analysis, eGFR < 45 ml/min/1.73 m2 was independently associated with ICAS after correction for covariates, odds ratio (OR) = 1.69, 95% confidence interval (CI) (1.08, 2.65); in particular, this association had a preference for posterior circulation but not anterior circulation ICAS with OR = 2.29, 95% CI (1.28, 4.07) and OR = 1.44, 95%CI (0.89, 2.33), respectively.Conclusion: Severe eGFR decline is associated with ICAS in the middle-aged and elderly population, and this correlation is more related to posterior circulation ICAS.

Correlation between the distribution of intracranial and extracranial aterial lesions and risk factors in Chinese patients with ischemic stroke: a multicenter registry study

Objective To investigate the distribution characteristics and risk factors of intracranial and extracranial aterial lesions in Chinese patients with ischemic stroke. Methods In this multi-center study, 2 310 continuously inpatients with ischemic stroke diagnosed in 20 stroke screening and prevention project base hospitals from June 2015 to May 2016 were enrolled. Carotid ultrasonography and transcranial color-coded sonography or transcranial Doppler were performed in all patients to confirm the presence of cerebral artery stenosis or occlusion. According to the distribution of lesions, the subjects were divided into 2 groups: the simple intracranial artery stenosis group and the simple extracranial artery stenosis group. The difference of risk factors between the two groups was compared. Results Of the 2 310 patients with ischemic stroke, 1 516 (65.6%) had simple intracranial artery stenosis and 794 (34.4%) had simple extracranial artery stenosis. The incidence of anterior circulation artery stenosis was higher in the group of intracranial artery stenosis than that in the extracranial artery stenosis group (68.1% vs 48.7%, P<0.001). Posterior circulation artery stenosis and combined anterior with posterior circulation artery stenosis were more common in patients with extracranial artery stenosis group than those in intracranial artery stenosis group (36.4% vs 22.1%, 14.9% vs 9.8%; all P<0.001). Univariate analysis of risk factors for stroke showed that patients with intracranial arterial stenosis had a higher prevelence of hypertension, diabetes, obesity, and family history of stroke, and their systolic blood pressure, diastolic blood pressure, body mass index (BMI), fasting blood-glucose, glycosylated hemoglobin, triacylglycerol, total cholesterol, and low-density lipoprotein cholesterol were significantly higher than those in the extracranial arterial stenosis group (all P<0.05). The proportion of elderly (≥65 years old), male and smokers in the extracranial arterial stenosis group was significantly higher than that in the intracranial arterial stenosis group (all P<0.05). Multivariate logistic regression analysis showed that elderly (≥65 years old), male, and smoking history were independent risk factors for extracranial arterial stenosis (OR=2.012, 1.637, 1.325, respectively; all P<0.05). While hypertension, diabetes, less physical activity, and high BMI levels were independent risk factors for simple intracranial arterial disease (OR=1.301, 1.252, 1.248, 1.030, respectively; all P<0.05). Conclusions There are significant differences in the distribution characteristics and risk factors of intracranial and extracranial aterial lesions in patients with ischemic stroke in China. Key words: Ultrasonography; Ischemic stroke; Atherosclerosis; Distribution; Risk factor

Association of Cardioembolism and Intracranial Arterial Stenosis with Outcomes of Mechanical Thrombectomy in Acute Ischemic Stroke

To estimate the association of different etiologies of cardioembolism (CE), intracranial arterial stenosis (ICAS), or the combination of these conditions with outcomes of mechanical thrombectomy in acute ischemic stroke. Data from the intervention group of the Endovascular therapy for Acute ischemic Stroke Trial (EAST) were analyzed. In 140 patients, the presence of CE, ICAS, neither CE nor ICAS, or both conditions was assessed. The primary outcome was a favorable outcome at 90 days (modified Rankin Scale score 0-2); secondary outcomes included successful reperfusion (modified Thrombolysis In Cerebral Infarction grade 2b-3), symptomatic intracerebral hemorrhage, and 90-day mortality. Of 140 patients, 47 had neither CE nor ICAS, 35 had ICAS but not CE, 46 had CE but not ICAS, and 12 had both CE and ICAS. The rate of favorable outcome was 67.1% in the no CE and no ICAS group, 74.3% in the ICAS without CE group, 41.3% in the CE without ICAS group, and 33.3% in the CE and ICAS group. The CE and ICAS group had poor outcomes (odds ratio= 0.20 after adjusting for age, sex, and National Institutes of Health Stroke Scale score; 95% confidence interval, 0.04-0.95; P= 0.043). No significant differences were observed in secondary outcomes. The presence of both CE and ICAS was associated with poor outcome in patients with anterior circulation large-vessel occlusion treated with endovascular thrombectomy. Future studies are warranted to further explore this association.

Analysis of Radiation Effects in Digital Subtraction Angiography of Intracranial Artery Stenosis

Intracranial artery stenosis (IAS) is the most common cause for acute cerebral accidents. Digital subtraction angiography (DSA) is the gold standard to detect IAS and usually brings excess radiation exposure to examinees and examiners. The artery pathology might influence the interventional procedure, causing prolonged radiation effects. However, no studies on the association between IAS pathology and operational parameters are available. A retrospective analysis was conducted on 93 patients with first-ever stroke/transient ischemic attack, who received DSA examination within 3 months from onset in this single center. Comparison of baseline characteristics was determined by 2-tailed Student's t-test or the chi-square test between subjects with and without IAS. A binary logistic regression analysis was performed to determine the association between IAS pathology and the items with a P value <0.05 in Student's t-test or chi-square test. There were 93 candidates (42 with IAS and 51 without IAS) in this study. The 2 groups shared no significance of the baseline characteristics (P > 0.05). We found a significantly higher total time, higher kerma area product, greater total dose, and greater DSA dose in the IAS group than in those without IAS (P < 0.05). A binary logistic regression analysis indicated the significant association between total time and IAS pathology (P < 0.05) but no significance in kerma area product, radiation dose, and DSA dose (P > 0.05). IAS pathology would indicate a prolonged total time of DSA procedure in clinical practice. However, the radiation effects would not change with pathologic changes.

High-sensitive C-reactive protein and dual antiplatelet in intracranial arterial stenosis.

To determine the relationship of high-sensitive C-reactive protein (hsCRP) and the efficacy and safety of dual antiplatelet therapy in patients with and without intracranial arterial stenosis (ICAS) in the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. A subgroup of 807 patients with both magnetic resonance angiography images and hsCRP measurement was analyzed. Cox proportional hazards models were used to assess the interaction of hsCRP levels with the effects of dual and single antiplatelet therapy. A total of 358 (44.4%) patients had ICAS and 449 (55.6%) did not. The proportion of patients with elevated hsCRP levels was higher in the ICAS group than in the non-ICAS group (40.2% vs 30.1%, p = 0.003). There was significant interaction between hsCRP and the 2 antiplatelet therapy groups in their effects on recurrent stroke after adjustment for confounding factors in the patients with ICAS (p = 0.012), but not in those without (p = 0.256). Compared with aspirin alone, clopidogrel plus aspirin significantly reduced the risk of recurrent stroke only in the patients with ICAS and nonelevated hsCRP levels (adjusted hazard ratio 0.27; 95% confidence interval 0.11 to 0.69; p = 0.006). Similar results were observed for composite vascular events. No significant difference in bleeding was found. Presence of both ICAS and nonelevated hsCRP levels may predict better response to dual antiplatelet therapy in reducing new stroke and composite vascular events in minor stroke or high-risk TIA patients. Further large-scale randomized and controlled clinical trials are needed to confirm this finding.

Meta-analysis of risk factors of Chinese patients with different cerebral artery stenosis locations

We conducted a Meta-analysis to explore the relationship between different locations of cerebral artery stenosis and the risk factors in Chinese ischemic cerebral artery disease patients. We systematically searched electronic literature databases (last search 31 December 2014) for studies reporting the association between cerebral artery stenosis locations and risk factors of ischemic cerebral artery disease. We grouped patients into two groups, only intracranial artery stenosis group and only extracranial artery stenosis group, by the location of cerebral artery stenosis. Meta-analysis was carried out by Review Manager (Version 5.2) provided by Cochrane Collaboration. After the heterogeneity test, the odds ratios (OR) or the mean differences (MD) and 95% confidence interval (95% CI) were combined. The publication bias and sensitivity analysis were tested as while. A total of thirteen studies were identified, which are including 1 672 patients with intracranial artery stenosis and 1 239 patients with extracranial artery stenosis. The only intracranial artery stenosis patients tend to be younger than the patients of the other group. The combined MD (95% CI) of age was -4.57 (-8.22--0.91, P=0.01). Besides, the proportion of smokers in the only intracranial artery stenosis patients was higher than the other group. The combined OR (95% CI) of smoking was 0.08 (0.68-0.93, P=0.005). As to Chinese ischemic cerebral artery disease patients, visible differences of age and smoking were detected between the only intracranial artery stenosis group and extracranial group. However some risk factors of cerebral artery stenosis which were proved by large scale studies, such as hypertension, diabetes and dyslipidemia, were failed to test the visible difference between the two groups.

Endovascular treatment and the outcomes of atherosclerotic intracranial stenosis in patients with hyperacute stroke.

The importance of underlying atherosclerotic intracranial artery stenosis (ICAS) in hyperacute stroke patients who receive endovascular therapy remains unknown. To report and compare the outcomes of multimodal endovascular therapy in patients with hyperacute stroke with and without underlying ICAS. A total of 172 consecutive patients with acute stroke were treated with multimodal endovascular therapy that was heavily weighted toward stent-based thrombectomy. Patients with ICAS underwent emergent intracranial angioplasty or stenting. Data were compared between patients with and without ICAS. Revascularization was defined as Thrombolysis in Cerebral Infarction grade ≥2b. A favorable outcome was defined as a modified Rankin Scale score ≤2 or equal to the premorbid modified Rankin Scale score at 3 months. ICAS was responsible for acute ischemic symptoms in 40 patients (22.9%). Revascularization and favorable outcome occurred more frequently in the ICAS group than in the control group (95% vs 81.8%, P = .04; 65% vs 40.2%, P = .01, respectively). The median baseline National Institutes of Health Stroke Scale score was significantly lower in the ICAS group compared with the control group (10 vs 12; P = .002). There were no significant differences between the 2 groups in the rates of symptomatic hemorrhage and mortality. Emergent intracranial angioplasty with or without stenting is safe and feasible and yields a high rate of revascularization and favorable outcome in patients with hyperacute stroke and underlying ICAS. Patients with underlying ICAS have less severe infarctions at presentation and higher successful revascularization after multimodal endovascular therapy in the setting of hyperacute stroke compared with those with other stroke subtypes.

Abstract T P11: What Clinical Factors Predict An Intracranial Arterial Stenosis Responsible For An Intracranial Larger Artery Occlusion Treated By Endovascular Therapy?

Objectives: In Asian countries where intracranial arterial stenosis (ICAS) is a common etiology regarding large artery intracranial occlusions in stroke. We sought to identify any clinical, laboratory and baseline imaging variables that may predict ICAS prior to endovascular treatment compared with angiographically-defined embolism (ADE). Methods: Patients were included if they had large cerebral artery occlusion in stroke on CT angiography and undertook transfemoral cerebral angiography, and if their onset to puncture time was within 8 hours. We defined ICAS and ADE by transfemoral cerebral angiography. ICAS was defined as fixed significant (&gt; 50%) focal stenosis in the occlusion site, which could be seen in the final angiography or during the procedure of endovascular treatment. ADE was defined by no focal stenosis was evident after some recanalization achieved. Patients were excluded if their cause of stroke was associated or combined with other etiologies. Results: Finally, a total of 157 patients were included for this study. Table shows comparisons of clinical laboratory and imaging characteristics between ICAS and ADE groups. Patients in ICAS group were younger and male-predominant than in those in ADE group. Dyslipidemia and smokers were more frequent in ICAS group. Total cholesterol level was higher in ICAS group than in ADE group. Compared to ADE an ICAS was much more common in the posterior circulation 11/30 versus only 12/127 in the anterior circulation (p&lt;0.001). Independent predictors of ICAS on multivariable analysis were male gender (odds ratio 6.34 [95% CI, 1.23-32.85], p=0.028), posterior circulation involvement (5.37 [1.62-17.82], p=0.006) and total cholesterol level (1.02 [1.004-1.033], p=0.012). Conclusion: The neurointerventionalist should prepare for the possibility of ICAS when performing endovascular treatment especially with posterior circulation occlusions in a Korean population.

3602: Carotid atherosclerosis, intracranial artery stenosis and cerebral white matter lesions

Objectives: Intima-media thickness (IMT) of the carotid artery serves as a marker of general atherosclerosis and the association of IMT with ischemic stroke has been documented. The purpose of this study is to evaluate the association of IMT, intracranial artery stenosis and cerebral white matter lesions (WMLs).Methods: We collected data of B-mode ultrasound graphic measurements of carotid IMT and brain MRI and MRA from 712 acute ischemic stroke patients admitted to Korea University Ansan Hospital between January 2003 and December 2004. The mean age was 64.3 ± 15.2 years and 60.1% were male. Based on MRI/MRA finding, intracranial artery stenosis was defined and WMLs were rated.Results: Sixty-one percent of patients had intracranial artery stenosis on brain MRA. We found significant difference in age and carotid IMT between intracranial artery stenosis group and nonstenosis group. With increasing number of plaques in the carotid artery the severity of WMLs increased (p < 0.005). The carotid IMT was 0.54 ± 0.21 mm for nonstenosis group and 0.88 ± 0.24 mm for stenosis group (p < 0.001). The age and carotid IMT were associated with intracranial stenosis independently on multivariate logistic regression test.Conclusions: This study suggest that certain pathogenetic mechanisms are involved in the association with carotid IMT, intracranial artery stenosis and WMLs. Objectives: Intima-media thickness (IMT) of the carotid artery serves as a marker of general atherosclerosis and the association of IMT with ischemic stroke has been documented. The purpose of this study is to evaluate the association of IMT, intracranial artery stenosis and cerebral white matter lesions (WMLs). Methods: We collected data of B-mode ultrasound graphic measurements of carotid IMT and brain MRI and MRA from 712 acute ischemic stroke patients admitted to Korea University Ansan Hospital between January 2003 and December 2004. The mean age was 64.3 ± 15.2 years and 60.1% were male. Based on MRI/MRA finding, intracranial artery stenosis was defined and WMLs were rated. Results: Sixty-one percent of patients had intracranial artery stenosis on brain MRA. We found significant difference in age and carotid IMT between intracranial artery stenosis group and nonstenosis group. With increasing number of plaques in the carotid artery the severity of WMLs increased (p < 0.005). The carotid IMT was 0.54 ± 0.21 mm for nonstenosis group and 0.88 ± 0.24 mm for stenosis group (p < 0.001). The age and carotid IMT were associated with intracranial stenosis independently on multivariate logistic regression test. Conclusions: This study suggest that certain pathogenetic mechanisms are involved in the association with carotid IMT, intracranial artery stenosis and WMLs.