Intracranial Atherosclerosis Group Research Articles

A novel etiological classification in patients with intracranial large vessel occlusion and endovascular treatment: discordance with the classic and SSS TOAST systems: A retrospective cohort study

Purpose: Among patients with acute ischemic stroke (AIS), those with intracranial large vessel occlusion (LVO) should undertake endovascular treatment (EVT) based on mechanical thrombectomy. Although the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification system has been used in overall population of patients with AIS, especially for secondary prevention. In the current study, a new classification system for the LVO population is proposed.Methods: The classic TOAST and Stop Stroke Study TOAST (SSS TOAST) were applied to the LVO population. Based on discordance with those systems, a new LVO classification system was developed and applied to the LVO population. The new system comprised extracranial atherosclerosis (ECAS), intracranial atherosclerosis (ICAS), cardioembolism (CE), cryptogenic embolism, stroke of undetermined etiology (SUE; two or more etiologies), and stroke of other determined etiology (SOE) where small artery occlusion was removed.Results: The LVO classification system comprised 43 ECAS (6.52%), 141 ICAS (21.36%), 303 CE (45.91%), 75 cryptogenic embolism (11.36%), 75 SUE (11.36%; cardioembolic source in 98.67%), and 23 SOE (3.48%) patients. The ICAS group had a significantly longer median onset-to-puncture time than the other groups. In the ICAS group, 102 of 141 (72.34%) remained partial recanalization after EVT.Conclusion: The LVO classification system differentiating ECAS and ICAS in patients with large artery atherosclerosis and classifying cryptogenic embolism is more suitable for patients with EVT for intracranial LVO. Further studies for predicting underlying ICAS and planning treatment strategy should be performed.

Study of Risk Factors and Outcome Evaluation in Patients with Stroke with Intracranial versus Extracranial Atherosclerotic Arterial Disease (P14-5.020)

<h3>Objective:</h3> To study the differences in risk factors between stroke caused by intracranial atherosclerosis (ICAS) and extracranial atherosclerosis (ECAS) in the Indian population. <h3>Background:</h3> Stroke is a multi-factorial disease occurs due to the combination of risk-factors. Pathogenic mechanism of intracranial atherosclerosis (ICAS) and extracranial atherosclerosis (ECAS) vary, hence exploring the risk factors of these subtypes is essential for targeting preventive therapy and to influence choice of management. <h3>Design/Methods:</h3> 100 patients presenting with acute ischemic stroke with clinically significant atherosclerosis in intra-cranial/extra-cranial arteries were compared with respect to their risk factors, presentation, progression and outcomes. <h3>Results:</h3> There were 35 ICAS, 52 ECAS and 13 with both ICAS &amp; ECAS. Mean age of the patients, gender, body mass index was not associated with their stroke type. Medical history of IHD and CKD was more common in patients with ICAS. Median (IQR) NIHSS of our study cohort was 12.97 (4.23) at 3 months. It was significantly higher in ICAS group (median = 16.26) as compared to that in the ECAS group (median = 10.92). Anterior circulation strokes were observed in 78% of patients, more commonly occurring in ECAS stroke group. Median (IQR) mRS score of the study cohort at 3 months was 1 (1.00), four patients died (mRS = 6) three of ICAS and one patients with both ICAS &amp; ECAS. ECAS group had significantly more proportion of patients with favorable mRS as compared to ICAS group. After adjusting for all possible confounders, only increasing NIHSS at admission was significantly associated with poor outcomes at 3 months. Stroke type did not significantly affect the the clinical outcome at 3 months. <h3>Conclusions:</h3> Although ICAS and ECAS shared similar risk factors, differences still existed between them as far as clinical outcomes are concerned. With higher NIHSS at admission, ICAS patients are at an increased risk for poor clinical outcome. <b>Disclosure:</b> Dr. Patel has nothing to disclose. Dr. Ponda has nothing to disclose.

Helicobacter pylori Infection Acts as an Independent Risk Factor for Intracranial Atherosclerosis in Women Less Than 60 Years Old.

Background: Studies show inconsistent results regarding the relationship between Helicobacter pylori (H. pylori) infection and stroke. The present study assessed a potential association between H. pylori infection and an important risk factor for stroke, intracranial atherosclerosis.Methods: In total, 15,798 subjects with transcranial Doppler (TCD) and 13C-urea breath test (13C-UBT) were enrolled from March 2012 to March 2017. Intracranial atherosclerosis was further measured using intracranial carotid artery calcification (ICAC) on past or recent head CT, and 14,084 subjects were ultimately included in the study. Baseline demographics, atherosclerosis risk factors, and laboratory results were investigated. Since endothelial dysfunction is critical to the development of atherosclerosis, the role of H. pylori in migration, tube formation, and proliferation of human brain microvascular endothelial cells (HBMECs) was assessed in vitro.Results: The intracranial atherosclerosis group had a higher proportion of women and a greater rate of H. pylori infection than those without intracranial atherosclerosis. H. pylori infection was significantly more common in women with intracranial atherosclerosis than males. In addition, the incidence of intracranial atherosclerosis was significantly higher in women with H. pylori infection than uninfected women (53.8 vs. 46.4%, p < 0.001). In an adjusted model, H. pylori was shown to be an independent risk factor for intracranial atherosclerosis in women ≤ 60 years of age [odds ratio (OR) = 2.261, 95% CI = 1.839–2.780, p < 0.001]. Serum exosomes from patients with H. pylori infection had significantly reduced brain endothelial cell migration, tube formation, and proliferation in vitro.Conclusion: Helicobacter pylori infection may be an important independent risk factor for intracranial atherosclerosis in women ≤ 60 years of age.

High-on-Aspirin Platelet Reactivity Differs Between Recurrent Ischemic Stroke Associated With Extracranial and Intracranial Atherosclerosis.

Background and PurposeIschemic stroke recurs despite the use of antiplatelet agents. Various mechanisms are involved in recurrence due to intracranial atherosclerosis (ICAS) and extracranial atherosclerosis (ECAS). High-on-aspirin platelet reactivity (HAPR) may differ between recurrent stroke due to ICAS and ECAS.MethodsPatients with recurrent ischemic stroke as a result of large-artery atherosclerosis despite taking aspirin were enrolled consecutively. Ischemic stroke was classified as stroke due to ICAS or ECAS according to the location of the culprit stenosis. An aspirin reaction units (ARU) value of >550 IU was defined as HAPR. HAPR and its associated factors were compared between the two groups and also considering the mechanism of stroke.ResultsAmong the 190 patients with recurrent stroke (111 with ICAS and 79 with ECAS), 36 (18.3%) showed HAPR. The ARU value was higher in the ECAS than the ICAS group (492±83 vs. 465±78, mean±standard deviation; p=0.028), as was the proportion of patients with HAPR (27.8% vs. 12.6%, p=0.008). Being male and having stroke due to ECAS (reference=stroke due to ICAS: odds ratio=5.760; 95% confidence interval=2.154–15.403; p<0.001) was independently associated with HAPR. The ARU value differed according to the stroke mechanism, and was highest in those with artery-to-artery embolism. Artery-to-artery embolism was independently associated with HAPR in both the ICAS and ECAS groups.ConclusionsRecurrent stroke due to ECAS was more strongly associated with HAPR and insufficient antiplatelet inhibition than was that due to ICAS. Artery-to-artery embolism was associated with HAPR in recurrent ischemic stroke as a result of ICAS or ECAS.

Feasibility and safety of the strategy of first stenting without retrieval using Solitaire FR as a treatment for emergent large-vessel occlusion due to underlying intracranial atherosclerosis.

The optimal treatment for underlying intracranial atherosclerosis (ICAS) in patients with emergent large-vessel occlusion (ELVO) remains unclear. Reocclusion during endovascular treatment (EVT) occurs frequently (57.1%-77.3%) after initial recanalization with stent retriever (SR) thrombectomy in ICAS-related ELVO. This study aimed to compare treatment outcomes of the strategy of first stenting without retrieval (FRESH) using the Solitaire FR versus SR thrombectomy in patients with ICAS-related ELVO. The authors retrospectively reviewed consecutive patients with acute ischemic stroke and intracranial ELVO of the anterior circulation who underwent EVT between January 2017 and December 2019 at Yeungnam University Medical Center. Large-vessel occlusion (LVO) of the anterior circulation was classified by etiology as follows: 1) no significant stenosis after recanalization (embolic group) and 2) remnant stenosis > 70% or lesser degree of stenosis with a tendency toward reocclusion and/or flow impairment during EVT (ICAS group). The ICAS group was divided into the SR thrombectomy group (SR thrombectomy) and the FRESH group. A total of 105 patients (62 men and 43 women; median age 71 years, IQR 62.5-79 years) were included. The embolic, SR thrombectomy, and FRESH groups comprised 66 (62.9%), 26 (24.7%), and 13 (12.4%) patients, respectively. There were no significant differences between the SR thrombectomy and FRESH groups in symptom onset-to-door time, but puncture-to-recanalization time was significantly shorter in the latter group (39 vs 54 minutes, p = 0.032). There were fewer stent retrieval passes but more first-pass recanalizations in the FRESH group (p < 0.001). Favorable functional outcomes were significantly more frequent in the FRESH group (84.6% vs 42.3%, p = 0.017). This study's findings suggest that FRESH, rather than rescue stenting, could be a treatment option for ICAS-related ELVO.

Abstract MP43: Paradoxical Response to Antibodies in Periodontal Microbes in Subjects With Intracranial Atherosclerotic Stenosis

Introduction: Previously we have shown that periodontal disease and systemic inflammation are related to intracranial atherosclerosis (ICAS) in Atherosclerosis Risk In Communities study (ARIC). In this study we evaluated the relationship between serum antibodies against periodontal pathogens and ICAS. Methods: In this ongoing, prospective, longitudinal community-based cohort study, participants were assessed for antibodies to periodontal organisms including Porphyrmonas gingivalis (PG), Prevotella intermedia (PI), Prevotella nigrescens (PN), Bacteriodes forsythensis (BF), Treponema denticola (TD), Actinobacillus actinomycetemcomitans (AA), Campylobacter rectus (CR), Eikenella corrodens (EC), Fusobacterium nucleatum (FN), Peptostreptococcus micros (PM), Selenomonas noxia (SN), Capnocytophaga ochracea (CO), Veillonella parvula (VP), Streptococcus sanguinis (SS), Streptococcus intermedius (SI), Streptococcus oralis (SO), Actinomycosis viscosis (AV) and Helicobacter pylori (HP). These participants underwent 3D time-of-flight magnetic resonance angiography (MRA) to evaluate ICAS. Log mean antibody (IgG), CRP and IL-6 levels were compared using t-test between groups with and without ≥50% ICAS. Results: In this ARIC cohort, 1066 participants were assessed by MRA for ICAS. Serum CRP and IL-6 data were available for all and IgG levels were available for 772 participants. The log mean IgG level was significantly lower for patients with ≥50% ICAS versus patients with &lt;50% ICAS in four organisms: PN (1.69 vs 1.80, p= 0.03 ), BF (1.30 vs 1.38, p=0.05 ), CO (1.23 vs 1.33, p= 0.04 ), FN (0.87 vs 1.01, p=0.02 ). The log mean IgG was also lower for CR, EC, SN, VP, SI, SO and AV though not significant. Log mean CRP was higher in the ≥50% ICAS group versus the &lt;50% ICAS group (0.58 vs. 0.47, p &lt; 0.001 ). Log mean IL-6 levels were also higher but not significant (0. 17 vs. 0.11, p= 0.07 ). Conclusion: Higher levels of systemic inflammatory markers (CRP, IL-6) are associated with significant ICAS, but we report a significantly lower level of IgG antibodies to specific periodontal pathogens (PN, BF, CO and FN) in patients with ≥50% ICAS. This paradoxical finding may represent the effect of systemic inflammation and oxidative stress on IgG levels to periodontal bacteria.

Role of the RNF213 Variant in Vascular Outcomes in Patients With Intracranial Atherosclerosis.

BackgroundThe RNF213 (ring finger protein 213 gene) variant R4810K is a susceptibility allele not only for Moyamoya disease (MMD) but also for intracranial atherosclerosis (ICAS) in East Asian populations. We hypothesized that this variant would affect the distribution of ICAS and recurrence of cerebrovascular events.Methods and ResultsWe conducted a prospective study of patients with ICAS and MMD using high‐resolution magnetic resonance imaging and RNF213 R4810K genotyping. Patients were included in the ICAS group when relevant plaques existed on high‐resolution magnetic resonance imagingand in the MMD group when they carried the variant and high‐resolution magnetic resonance imaging showed no plaques but characteristic features of MMD. We compared clinical and neuroimaging features of patients with ICAS‐RNF213+ with patients with ICAS‐RNF213− and of patients with MMD. Of 477 patients, 238 patients were in the ICAS group and 239 were in the MMD group. Among patients with ICAS, 79 patients (33.2%) were in the ICAS‐RNF213+ group and 159 (66.8%) in the ICAS‐RNF213− group. Tandem lesions were significantly more common in the ICAS‐RNF213+ group than in the ICAS‐RNF213− group (40.3% versus 72.2%, P<0.001), and their distributions were similar between the ICAS‐RNF213+ and MMD groups. The presence of the R4810K variant (hazard ratio [HR], 3.203; 95% CI, 1.149–9.459; P=0.026) and tandem lesions (≥3) (HR, 8.315; 95% CI, 1.930–39.607; P=0.005) were independently associated with recurrent cerebrovascular events.ConclusionsPatients with ICAS carrying the RNF213 R4810K variant showed clinical and imaging features distinct from patients with ICAS without the variant, suggesting that the R4810K variant plays a role in intracranial atherosclerosis in East Asian patients.

Intracranial Atherosclerosis Coexisting With White Matter Hyperintensities May Predict Unfavorable Functional Outcome in Patients With Acute Cerebral Ischemia.

Background and Purpose: This study aimed to assess the effect of baseline white matter hyperintensities (WMH) on 1-year stroke recurrence and the functional outcome for patients with intracranial atherosclerosis (ICAS).Methods: We analyzed 2,076 patients who were enrolled in the Chinese IntraCranial AtheroSclerosis (CICAS) study. ICAS and WMH were diagnosed by baseline magnetic resonance angiography. The primary outcomes were stroke recurrence and unfavorable functional outcome (modified Rankin Scale score 3–6) at 1 year.Results: Of the 2,076 patients included in this study, 1,370 (65.99%) were men, and the mean age was 61.70 years. In total, 224 (10.79%) patients had no WMH and no ICAS, 922 (44.41%) patients had WMH and no ICAS, 157 (7.56%) patients had ICAS and no WMH, and 773 (37.24%) had both WMH and ICAS. During the follow-up period, 87 patients had a recurrent stroke and 333 had unfavorable outcomes at 1 year. Compared to WMH (–) ICAS (–) group, the adjusted odd ratios and 95% confidence interval for unfavorable functional outcome were 0.791 (0.470–1.332; p = 0.3779) in the WMH (+) ICAS (–) group, 1.920 (1.024–3.600; p = 0.0421) in the WMH (–) ICAS (+) group, and 2.046 (1.230–3.403; p = 0.0058) in the WMH (+) ICAS (+) group. There was no significant difference in stroke recurrence risk among the four groups.Conclusion: ICAS coexisting with WMH may predict an unfavorable functional outcome at 1 year, but not stroke recurrence.

Association Between Occlusion Type and Etiology of Acute Intracranial Large Artery Occlusion.

Objective: To investigate the diagnostic efficiency of truncal-type occlusion and branching-site occlusion in determining the etiology of intracranial large artery occlusion related acute ischemic stroke (AIS).Methods: Patients with intracranial large artery occlusion related AIS who received stent retriever (SR) thrombectomy from November 2014 to June 2019 were included in the study. All patients underwent angiography before SR thrombectomy, which was used to evaluate the occlusion type. Differences in the distribution of occlusion types in intracranial atherosclerosis (ICAS) and embolism were assessed, and the diagnostic indicators, including the area under the ROC curve (AUC), sensitivity, and specificity were calculated.Results: Of the 115 AIS patients with intracranial large artery occlusion, 42 were classified as having ICAS, and 73 having an embolism. In the ICAS group, branching-site occlusion was responsible for 3 (7%) cases and truncal-type occlusion for 39 (93%) cases, while in the embolism group, branching-site occlusion was responsible for 66 (90%) cases and truncal-type occlusion for 7 (10%) cases; the difference was statistically significant (all P < 0.01). The AUC for ICAS predicted by truncal-type occlusion was 0.916, with a sensitivity of 92.86%, and specificity of 90.41%.Conclusion: Truncal-type occlusion showed a high predictability of ICAS. Determine the etiology of intracranial large artery occlusion related AIS before SR thrombectomy may be most helpful in setting up optimal endovascular treatment strategies.

Endovascular therapy for acute vertebrobasilar occlusion underlying atherosclerosis: A single institution experience

ObjectiveTo compare the safety and efficacy of endovascular therapy in acute ischemic stroke (AIS) caused by large artery occlusion (LAO) in the posterior circulation with or without intracranial atherosclerosis (ICAS). Patient and methodsThe study enrolled patients who underwent endovascular therapy for AIS caused by posterior circulation LAO. Inclusion criteria for endovascular therapy of vertebrobasilar occlusion were as follows: (1) CTA or MRA confirmed acute vertebrobasilar occlusion; (2) baseline NIHSS score ≥2; (3) premorbid mRS score ≤2; (4) onset or last known well time to puncture within 24 h; (5) pc-ASPECTS ≥6. Outcomes were compared between the ICAS group and the non-ICAS group. ResultsA total of 67 patients were recruited in this study, of which 35 (52.2%) had underlying ICAS, while 32 (47.8%) did not. Rescue therapies were more commonly performed in the ICAS group (82.9% vs. 34.4%; p = 0.000). The proportion of favorable outcome at 90 days was higher in the ICAS group than in the non-ICAS group (71.4% vs. 46.9%; p = 0.041). There was no significant difference in symptomatic ICH (2.9% vs. 6.3%, p = 0.603) or death within 90 days (22.9% vs. 37.5%, p = 0.191) between the two groups. The baseline GCS score (OR 1.281, 95% CI: 1.085–1.513; p = 0.004) and PMI (OR 0.402, 95% CI: 0.233 to 0.693; p = 0.001) were independently associated with favorable outcome at 90 days. ConclusionsEndovascular therapy with stent-retriever thrombectomy followed by rescue treatment can achieve high rates of successful revascularization and favorable outcome in the treatment of AIS caused by posterior circulation LAO.

Difference of one year death and stroke recurrence in ischemic stroke patients with anterior and posterior circulation intracranial atherosclerosis

Objective: To explore the differences of one year death and stroke recurrence between ischemic stroke patients with intracranial atherosclerotic stenosis or occlusion of anterior circulation and those of posterior circulation. Methods: All the patients were from the Chinese Intracranial Atherosclerosis Study (CICAS), between October 2007 and June 2009; patients with extracranial stenosis or occlusion, patients without acute infarction by diffusion weighted image, and patients with intracranial atherosclerosis of both anterior and posterior circulation were excluded.All the enrolled patients were divided into three groups: no significant intracranial atherosclerosis group (n=964), anterior circulation intracranial atherosclerosis group (n=440), posterior circulation intracranial atherosclerosis group (n=233). One year outcome was evaluated by any cause of death and stroke recurrence. Results: Of the 1 637 patients, 30 cases were died and 58 cases had stroke recurrence within one year.Compared with : no significant intracranial atherosclerosis group, adjusted hazard ratio (95% confidence interval) of one-year death for anterior and posterior circulation intracranial atherosclerosis group were 1.349 (0.311-5.851), 4.542 (1.227-16.813), respectively.Adjusted hazard ratio (95% confidence interval) of one year stroke recurrence were 1.663 (0.620-4.460) and 2.464 (0.935-6.493), respectively. Conclusions: Ischemic stroke patients with intracranial atherosclerosis of posterior circulation has higher risk of one year death. One year stroke recurrence risk for patients with intracranial atherosclerosis of anterior and posterior circulation needs to be further evaluated.

Mechanical thrombectomy and rescue therapy for intracranial large artery occlusion with underlying atherosclerosis

ObjectiveTo investigate the safety and efficacy of mechanical thrombectomy plus rescue therapy for intracranial large artery occlusion (ILAO) with underlying intracranial atherosclerosis (ICAS).MethodsPatients enrolled in the intervention group of EAST...

Cerebral white matter hyperintensity is associated with intracranial atherosclerosis in a healthy population

Background and aimsCerebral white matter hyperintensity (WMH) is commonly found in ischemic stroke patients, especially when accompanied by intracranial atherosclerosis (ICAS). However, the relationship between WMH and ICAS in a healthy population has not been evaluated. MethodsA total of 3159 healthy subjects who underwent health checkups, including brain magnetic resonance imaging and angiography, were enrolled. ICAS was defined as an occlusion or more than 50% stenosis of intracranial vessels on magnetic resonance angiography. Volumes of WMH were quantitatively rated. ResultsEighty-two (2.6%) subjects had ICAS. The mean age of the cohort was 56 years, and the median volume of WMH was 1.02 [0.20–2.60] mL. In a multivariate analysis, ICAS [β = 0.331, 95% confidence interval (CI) = 0.086 to 0.576, p = 0.008] was significantly associated with WMH volumes after adjusting confounders. Age (β = 0.046, 95% CI = 0.042 to 0.050, p < 0.001), hypertension (β = 0.113, 95% CI = 0.017 to 0.210, p = 0.021), and diabetes (β = 0.154, 95% CI = 0.043 to 0.265, p = 0.006) were also significant, independently of ICAS. The ICAS (+) group had more frequent vascular risk factors including hypertension, diabetes, and statin use, than the ICAS (−) group, and these tendencies increased when WMH was accompanied by ICAS. ConclusionsICAS is associated with larger WMH volume in a healthy population. Close observation of this group and strict control of vascular risk factors are needed.

Postprandial Clearance of Oxidized Low-Density Lipoprotein in Patients with Stroke Due to Atherosclerosis

Oxidized low-density lipoprotein (OxLDL) is a contributor to atherosclerosis development. OxLDL formation increases in the postprandial state due to oxidative stress in subjects with coronary artery disease (CAD) and diabetes, but has not been studied in patients with atherosclerotic stroke. We aimed to determine differences in postprandial OxLDL in patients with atherosclerotic stroke compared to stroke from other causes. Patients with ischemic stroke but no history of CAD (n = 42) were enrolled and categorized by stroke subtype as extracranial atherosclerosis (EC), n = 12; intracranial atherosclerosis (IC), n = 16; or other cause, n = 14. After fasting overnight, subjects consumed a standardized fat meal. OxLDL levels were measured at t = 0 and t = 4 hours postprandial using enzyme-linked immunosorbent assay. Comparisons between the mean changes in OxLDL between the groups were performed using the analysis of variance procedure. The IC group had the highest mean baseline level of OxLDL and the greatest decline during the postprandial period. There was a trend toward a difference in the mean change in OxLDL between the 3 groups (P = .0553). Subjects with atherosclerotic stroke (EC and IC groups) had higher fasting OxLDL and had a significant decline in OxLDL compared to those with stroke from other causes (P = .0164). Subjects with stroke due to atherosclerosis, particularly intracranially, demonstrated high fasting OxLDL and a decline in OxLDL during the postprandial period. This decline in OxLDL may indicate an accelerated clearance of OxLDL resulting from meal-induced oxidative stress.

Association of ADIPOQ single nucleotide polymorphisms with the risk of intracranial atherosclerosis

Background: The genetic mechanism of the racial distribution difference of intracranial atherosclerosis (ICAS) is unclear. The single nucleotide polymorphisms (SNPs) may be associated with different genetic susceptibility to ICAS. At present, the correlation between ADIPOQ gene SNPs and the risk of ICAS remains unknown. Methods: Continuous inpatients were selected and divided into ICAS group and control group. Computed tomography angiography was performed to observe intracranial arteries. ADIPOQ SNPs were detected using the ligase detection reaction-PCR. The correlation between the identified SNPs and ICAS was determined using the binary logistic regression analysis. Results: This study contained 602 patients in total, including 199 ICAS and 403 control cases. The binary logistic regression analysis showed that the AG/AA genotype of the rs2241767 (OR = 2.242, 95% CI: 1.037–4.878, P = 0.040) and the AG/GG genotype of the rs182052 (OR = 1.822, 95% CI: 1.111–2.987, P = 0.017) were closely related to the risk of ICAS after adjusting for conventional cardiovascular risk factors. The haploid analysis results indicated that the incidence of the A-G haplotype of the rs2241767 and rs182052 was higher in the ICAS group than in the control group (P = 0.026). Conclusions: The SNPs of the ADIPOQ gene are closely related to increased risk of ICAS in Chinese Han population.

Incidence and Risk Factors of Intracranial Atherosclerotic Stroke: The Northern Manhattan Stroke Study

Background: To assess the prevalence of risk factors as determinants of intracranial atherosclerosis (IATH)-related stroke in a multi-ethnic community-based cohort. Methods: The Northern Manhattan Stroke Study included a population-based incidence study and a nested case-control study. Incident cases of first ischemic stroke were 1:2 when matched to community controls by age, sex, and race/ethnicity. Vascular risk factors were assessed among controls and compared against the following stroke subtypes: IATH, extracranial atherosclerosis (EATH), and non-atherosclerotic (NATH: cardioembolic, lacunar, and cryptogenic). Conditional logistic-regression was used to determine the association between risk factors and stroke subtypes. Results: The crude incidence of IATH was 8/100,000 per year and the relative incidence of IATH was higher than that of EATH in blacks (5.9 vs. 3.2/100,000 per year) and in Hispanics (5.0 vs. 1.7/100,000 per year). The IATH group had a higher prevalence of diabetes mellitus (DM; 67% IATH, 60% EATH, 48% NATH, and 23% controls; p < 0.05 IATH vs. control) and of metabolic syndrome (62% IATH, 40% EATH, 40% NATH, and 35% controls; p < 0.05 IATH vs. control). In multivariate analysis, DM conferred a higher risk for IATH versus NATH stroke (OR, 10.8; 95% CI, 2.0–57 vs. OR, 2.7; 95% CI, 1.9–3.9; p < 0.05) and much lower for EATH (OR, 6.2; 95% CI, 1.2–32). The metabolic syndrome conferred a higher risk for IATH stroke subtype (OR, 4.6; 95% CI, 1.1–18.7) when compared to EATH (OR, 2.3; CI, 0.6–9.1) and NATH (OR, 2.4; CI, 1.7–3.3). Conclusions: DM is a more important determinant for IATH-related stroke than EATH or NATH.

Adiponectin levels in patients with intracranial atherosclerosis

Adiponectin is a protein secreted by adipose cells that improves insulin sensitivity and possesses antiatherogenic properties. In this study, we investigated the relationship between adiponectin levels and ischemic stroke subtype. Using clinical, imaging, and laboratory data, 231 consecutive patients admitted to a university medical center over a 2-year period with acute cerebral infarcts were categorized into four subtypes: intracranial atherosclerosis (n = 67), extracranial atherosclerosis (n = 61), small arterial occlusion (n = 63), and cardioembolic (n = 40). Clinical features, risk factors including the presence of metabolic syndrome, and levels of s-adiponectin were compared between groups. Patients with more severe metabolic abnormalities were more likely to have lower s-adiponectin levels (p = 0.002). S-adiponectin levels differed by stroke subtype: highest in the cardioembolic group and lowest in the intracranial atherosclerosis group (8.42 +/- 5.07 vs 5.60 +/- 2.79 microg/mL, p = 0.01). Extracranial atherosclerosis (6.45 +/- 4.10 microg/mL) and small arterial occlusion (6.07 +/- 3.44 microg/mL) groups were intermediate. Patients with advanced intracranial atherosclerosis (> or =1 additional lesion outside the symptomatic arterial territory) had lower s-adiponectin levels than those with isolated intracranial atherosclerosis (4.95 +/- 2.63 vs 6.13 +/- 2.84 microg/mL, p = 0.003). In multiple regression analysis, s-adiponectin levels, but not metabolic syndrome, were independently associated with intracranial atherosclerosis. Symptomatic intracranial atherosclerosis is associated with lower s-adiponectin levels vs other ischemic stroke subtypes.