Intracranial Internal Carotid Artery Calcifications Research Articles

Imaging of intracranial arterial disease: a comparison between MRI and unenhanced CT.

Arterial calcifications on unenhanced CT scans and vessel wall lesions on MRI are often used interchangeably to portray intracranial arterial disease. However, the extent of pathology depicted with each technique is unclear. We investigated the presence and distribution of these two imaging findings in patients with a history of cerebrovascular disease. We analyzed CT and MRI data from 78 patients admitted for stroke or TIA at our institution. Vessel wall lesions were assessed on 7 T MRI sequences, while arterial calcifications were assessed on CT scans. The number of vessel wall lesions, severity of intracranial internal carotid artery (iICA) calcifications, and overall presence and distribution of the two imaging findings were visually assessed in the intracranial arteries. At least one vessel wall lesion or arterial calcification was assessed in 69 (88%) patients. Only the iICA and vertebral arteries (VA) showed a substantial number of both calcifications and vessel wall lesions. The other vessels showed almost exclusively vessel wall lesions. The number of vessel wall lesions was associated with the severity of iICA calcification (p = 0.013). The number of vessel wall lesions increases with the severity of iICA calcifications. Nonetheless, the distribution of vessel wall lesions on MRI and arterial calcifications on CT shows remarkable differences. These findings support the need for a combined approach to examine intracranial arterial disease.

Systemic arterial calcium burden in patients with chronic limb-threatening ischemia

Introduction5-year mortality of chronic limb-threatening ischemia (CLTI) is 50–60% and coronary artery disease (CAD) is the main cause of death of CLTI patients, followed by stroke. The aim of this study is to quantify and qualify the calcium load in different arterial territories in patients with CLTI. MethodsProspectively, 60 patients with CLTI were included and received a full-body CT scan. 6 patients were excluded. Different arterial territories (the peripheral lower extremity arteries, coronary arteries, extracranial and intracranial carotid arteries, thoracic and abdominal aorta) were analyzed. Analysis and interrelations of both quantitative and semi-quantitative CT measurements was performed. ResultsMean age was 72 years (range 47–95; SD 11.4). Almost all CLTI patients had calcified arterial beds (femoropopliteal 100%, crural 98.1%, coronary 100%, carotid bifurcation 96.2%, internal carotid artery 98.1%, thoracic aorta 96.2%, abdominal aorta 92.3%). Nearly all arterial territories had severe calcifications. 57% had a very high coronary Agatston score (>1000), and 35% extremely high (>2000). Calcifications in the lower extremity were significantly correlated to CAC score, carotid artery bifurcation calcification score, and to a lesser extent correlated to annular calcifications in the aorta. Very high and extremely high total CAC scores were strongly correlated with severe lower extremity arterial calcifications and severe carotid and intracranial internal carotid artery, thoracic and abdominal aorta calcifications in patients with CLTI patients. ConclusionsIn CLTI patients nearly all arterial territories are severely calcified, suggesting that systemic calcification plays an important role in the poor outcome of this disease.

Internal carotid artery calcifications in a South African population: A CBCT imaging study

AbstractBackgroundStroke is the second leading cause of death globally and account for 25,000 deaths annually in South Africa. Both medial and intimal located intracranial internal carotid artery (iICA) calcifications are associated with stroke. Cone beam computed tomography (CBCT) is commonly used where advanced dental imaging of the skull is required and often includes areas outside of the field of interest. Modalities such as CBCT have great potential to identify and provide early detection of calcifications during imaging for dental purposes. The aim of the study was to investigate the presence, distribution and extent of iICA calcifications in a South African population using CBCT images. Retrospectively collected CBCT data sets of 582 patients were evaluated. All data sets were evaluated for the presence, location and severity of calcifications within the course of the internal carotid artery.ResultsAge was associated with a higher prevalence of internal carotid artery (ICA) calcifications, but sex was not. Individuals older than 61 years presented with a high number of calcifications. In total, the presence of calcifications was found in 199 patients (i.e. 34.19% of the patients). White South African individuals showed the highest prevalence. A higher degree of calcifications was also present within the C4, C5 and C6 ICA segments.ConclusionsDetection of calcifications along the course of the ICA was possible using CBCT images taken for dental treatment purposes. Early detection of calcifications allows for appropriated referral and assessment which will be beneficial to the patient presenting with ICA calcifications.

Abstract P573: The Interplay Between Mineral and Skeletal Metabolism Biomarkers and Intracranial Internal Carotid Artery Calcifications in Stroke Patients

Background: Intracranial internal carotid artery calcifications (IICAC), considered a phenomenon within the spectrum of atherosclerosis and vascular aging, are frequently encountered in ischemic stroke patients. While intimal IICAC directly contributes to ischemic stroke pathophysiology, the medial counterpart is generally deemed as a risk factor for vascular end-points. Apart from aging and cardiovascular risk factors, the underlying pathophysiology that contributes to development of IICAC is not well understood; herein we studied the interplay between mineral and skeletal metabolism biomarkers, and IICAC presence and pattern. Methods: In a prospective series of 194 ischemic stroke patients (mean±SD age: 69±14 yr), blood samples were collected to determine calcium, phosphorus, magnesium, osteocalcin, parathyroid hormone, and vitamin D levels within 72 hours of symptom onset. IICAC presence and type was determined on admission CT-angiography source images; a medial or intimal type of IICAC category was assigned according to Kockelkoren criteria. Results: A total of 45 (23%) patients had no calcifications, while 95 (49%) had an intimal pattern and 54 (28%) had non-intimal (or medial) pattern. Apart from the well-known factors related with IICAC, such as age, lower glomerular filtration rate (GFR), history of hypertension, diabetes mellitus, coronary artery disease and atrial fibrillation, we identified admission magnesium levels to be associated with IICAC presence and pattern (no calcification: 1.96±0.18 mEq/L, intimal calcification 1.93±0.19 mEq/L, medial calcification: 1.81±0.28 mEq/L; p=0.006). None of the other biomarkers had any significant relationship to IICAC. In multivariate models, a lower magnesium level was significantly associated with medial calcification (each 0.1 mEq/L drop increased the odds by 1.2 (95% CI 1.0-1.4; p=0.046)), in addition to older age, history of diabetes mellitus and lower GFR. Conclusion: Hypomagnesemia is one of the factors well-known to be associated with vascular calcifications in the body. Our findings, extend this relationship to the intracranial vascular bed. No similar association was observed for other biomarkers related to mineral and skeletal metabolism. (Funding: TUBITAK grant 218S753)

Intracerebral hematoma expansion and intracranial internal carotid artery calcifications

Background and aimsPrediction of intracerebral hematoma expansion (IHE) is of critical importance during intracerebral hemorrhage (ICH) management. Given its suggested positive connection with cerebral microvascular disease status, intracranial internal carotid artery wall calcifications (ICAC) on admission computed tomography (CT) studies may contribute to prediction of IHE. MethodPresence, burden and type [as per Kockelkoren’s score] of ICAC were defined in admission CT and CT-angiography of 201 ICH patients [mean age: 70 ± 13 years, 44 % female]. A Kockelkoren’s score of <7 indicated intimal calcification [iICAC], while ≥7 indicated non-intimal [or medial] ones [mICAC]. IHE criteria were absolute volume increase of ≥12.5cc or ≥6cc, and relative increase ≥33 % or ≥26 %. ResultICAC was diagnosed in 79.6 % of ICH patients. ICAC status was not independent indicator of milder IHE (≥6cc and ≥26 % IHE, both in 27 %). Presence of contralateral mICAC was found to be an independent predictor for higher grade IHE (expβ = 3.44, 95 %CI: 1.47–8.04, for IHE ≥ 12.5cc, diagnosed in 14.4 %; and expβ = 2.67, 95 %CI: 1.29–5.55, for IHE ≥ 33 %, diagnosed in 24 %). Mortality (31 %) was higher in those with ipsilateral any type ICAC (36 % in mICAC, 38 % in iICAC, 17 % in no ICAC, p = 0.017), but this was not independent predictor in logistic regression. Similarly, medial ICAC in both ipsilateral (47 % vs. 31 %, p = 0.037) and contralateral (47 % vs. 30 %, p = 0.017) sides was associated with poorer prognosis (42 %) on univariate, but not multivariate analysis. ConclusionIntracranial ICA calcification is highly prevalent in ICH. mICAC may be associated with risk of “high amount” acute hematoma expansion, hospital mortality and poor prognosis.

Abstract TP563: White Matter Hyperintensities are Associated With Intracranial Internal Carotid Artery Calcifications in a Cohort of Patients With Acute Ischemic Stroke or Transient Ischemic Attack

Introduction: Previous studies of the relationship between cerebral small vessel disease (CSVD) lesions and carotid artery (CA) calcifications have yielded conflicting results. Hypothesis: We hypothesized that intracranial ICA (ICICA) calcifications are most closely associated with CSVD in comparison to extracranial ICA (ECICA) and common CA (CCA) calcifications. Methods: Acute ischemic stroke and transient ischemic attack patients were recruited into a hospital-based prospective stroke registry. Total CSVD burden score including white matter hyperintensity (WMH), lacunes, microbleeds (MBs) and enlarged perivascular spaces (PVS) was measured according to Staals et al. Fazekas scale was used to rate the periventricular and deep WMH (PVMH and DWMH respectively). ICICA calcifications were measured on plain head CT scan according to Subedi et al. ECICA and CCA calcifications were measured according to Yamada et al on the neck CT angiography. Univariate analyses were used to test the relationship between CSVD lesions and CA calcifications. Binary and ordered logistic regression analyses were performed to adjust for the effect of age, sex, race, history of hypertension, diabetes and current smoking for the variables that showed significance in the univariate analyses. Results: 141 patients (age 64.5±15.3, 49% females, total CSVD score 1.6±1.4, ICICA, ECICA and CCA calcification scores were 7.8±9.9, 10.3±13.4 and 2.1±6.9, respectively). In Univariate analyses, ICICA calcification score showed significant relationships with PVMH, DWMH, lacunes, MBs and total CSVD scores ( P values: &lt;0.0001, 0.0005, 0.0078, 0.049 and 0.0026 respectively). ECICA calcification score showed significant relationships with PVWMH and DWMH (P values: 0.0062 and 0.0332, respectively) while CC calcification score showed significant relationships with PVMWH, DWMH, MBs and PVS (P values: 0.0008, 0.034, 0.045 and 0.013). Multivariate analyses showed significant relationships only for PVWMH and DWMH with ICICA calcification (P values: 0.008 and 0.05, respectively). Conclusions: ICICA calcifications are most closely linked to PVMW and DWMH. Further studies are required to investigate the pathophysiological mechanisms behind this relationship.

Abstract WP538: Sex Differences in Intracranial and Extracranial Atherosclerosis in Patients With Acute Ischemic Stroke

Objective: To investigate sex differences in presence and location of atherosclerosis in a large population of acute ischaemic stroke patients. Methods: Participants were included from the Dutch acute stroke study (DUST), a large prospective multicentre cohort study. All patients received CT/CT-angiography within 9 hours of stroke onset. We assessed the presence of any sign of atherosclerosis in the intra- and extracranial circulation. In addition, we determined the burden of intracranial atherosclerosis by quantifying intracranial internal carotid artery (ICA) calcifications, resulting in calcium volumes. Relative risks between women and men were calculated using multivariable Poisson regression, and adjusted (aRR) for potential confounders (age, hypertension, hyperlipidemia, diabetes, smoking and alcohol use). Results: We included 1397 patients with a mean age of 67 years, of whom 600 (43%) were women. Presence of atherosclerosis in intracranial vessel segments was found as frequently in women as in men (71% versus 72%, aRR 0.95; 95%CI 0.89-1.01). In addition, intracranial ICA calcium volume did not differ between women and men (median volume 124 mm 3 , IQR 35.5-304.5 in women versus 112 mm 3 , IQR 33.0-276.5 in men; tertile largest volume 37% in women versus 33% in men, aRR 1.00; 95% CI 0.95-1.05). Extracranial atherosclerosis was less common in women compared with men (74% vs 81%, aRR 0.86; 95%CI 0.81-0.92). (Table) Conclusions: In patients with acute ischemic stroke the prevalence of intracranial atherosclerosis does not differ between women and men, while extracranial atherosclerosis is less often present in women compared with men.

Migraine and Cerebrovascular Atherosclerosis in Patients With Ischemic Stroke.

Migraine is a well-established risk factor for ischemic stroke, but migraine is also related to other vascular diseases. This study aims to investigate the association between migraine and cerebrovascular atherosclerosis in patients with acute ischemic stroke. We retrieved data on patients with ischemic stroke from the DUST (Dutch Acute Stroke Study). Migraine history was assessed with a migraine screener and confirmed by telephone interview based on the ICHD criteria (International Classification of Headache Disorders). We assessed intra- and extracranial atherosclerotic changes and quantified intracranial internal carotid artery calcifications as measure of atherosclerotic burden on noncontrast computed tomography and computed tomographic angiography. We calculated risk ratios with adjustments for possible confounders with multivariable Poisson regression analyses. We included 656 patients, aged 18 to 99 years, of whom 53 had a history of migraine (29 with aura). Patients with migraine did not have more frequent atherosclerotic changes in intracranial (51% versus 74%; adjusted risk ratio, 0.82; 95% confidence interval, 0.64-1.05) or extracranial vessels (62% versus 79%; adjusted risk ratio, 0.93; 95% confidence interval, 0.77-1.12) than patients without migraine and had comparable internal carotid artery calcification volumes (largest versus medium and smallest volume tertile, 23% versus 35%; adjusted risk ratio, 0.93; 95% confidence interval, 0.57-1.52). Migraine is not associated with excess atherosclerosis in large vessels in patients with acute ischemic stroke. Our findings suggest that the biological mechanisms by which migraine results in ischemic stroke are not related to macrovascular cerebral atherosclerosis.

Abstract T P171: Clinical and Imaging Features Associated with Intracranial Internal Carotid Artery Calcifications in Patients with Ischemic Stroke

Background: Intracranial internal carotid artery calcifications (ICAC), a radiologic feature frequently detected on imaging studies, have been shown to be associated with future stroke risk in population-based studies. The clinical significance of this observation among patients with ischemic stroke is, on the other hand, less clear. In this study we sought to identify features associated with ICAC burden in a consecutive series of ischemic stroke patients. Methods: The burden of ICAC was determined separately on non-contrast CT and CT-angiography by semi-quantitative scoring algorithms. The distribution of vascular risk factors, etiologic stroke subtype and calcification burden in other craniocervical arteries were assessed among patients with no ICAC, mild-moderate ICAC and severe ICAC. Results: Of the 319 patients included into the study, 28% had no ICAC, 35% had mild-moderate ICAC and 37% hade severe ICAC on CT-angiography source images. The corresponding figures were 22%, 38% and 41%, respectively, when the ratings were performed on non-contrast CT. Overall non-contrast CT and CT-angiography based ratings were highly correlated (r=0.90, p&lt;0.001). ICAC burden was significantly associated with older age, history of hypertension, diabetes mellitus, coronary artery disease and atrial fibrillation, higher prevalence of large artery atherosclerosis and cardio-aortic embolism as the underlying stroke subtype and presence of calcifications in other craniocervical vessels. Multivariate analyses revealed age, history of diabetes mellitus and coronary artery disease, together with a stroke etiology of large artery atherosclerosis, as factors independently associated with ICAC burden. Conclusion: ICAC burden as determined either by non-contrast CT or CT-angiography reflects a continuum of atherosclerotic disease involving the carotid arteries together with other craniocervical vascular beds. ICAC is significantly associated with large artery atherosclerosis related stroke and might thereby guide the clinician for therapeutic management and etiologic work-up during the acute period.

Clinical and imaging features associated with intracranial internal carotid artery calcifications in patients with ischemic stroke.

Intracranial internal carotid artery calcifications (ICAC), a frequent finding on imaging studies, are predictive of future stroke risk in population-based studies. The clinical significance of this observation among ischemic stroke patients is however less clear. In this study, we analyzed ICAC burden in relation to vascular risk factor profile, stroke etiology, and extent of craniocervical vascular calcifications in a consecutive series of ischemic stroke patients. The burden of ICAC was determined both on non-contrast CT and CT-angiography source images by semiquantitative scoring algorithms. The distribution of vascular risk factors, etiologic stroke subtype, and calcification burden in other craniocervical arteries was assessed among patients with no ICAC, mild-moderate ICAC, and severe ICAC. Of 319 patients included into the study, 28% had no ICAC, 35% had mild-moderate ICAC, and 37% had severe ICAC on CT angiography. Independent factors associated with ICAC burden in multivariate analysis included age (p < 0.001), diabetes mellitus (p = 0.006), and coronary artery disease (p < 0.001). Furthermore, a stroke etiology of large artery atherosclerosis or cardioaortic embolism was significantly related to higher ICAC burden (p = 0.006). Patients with severe ICAC were more likely to harbor calcifications in other vascular beds (p < 0.001). All of these findings persisted when analyses were repeated with CT-based ICAC burden assessments. ICAC burden reflects a continuum of atherosclerotic disease involving carotid arteries together with other craniocervical vascular beds. ICAC is significantly associated with stroke of large vessel or cardioembolic origin. This information might help the clinician in prioritizing etiologic work-up in the acute period.

Quantification of intracranial internal carotid artery calcification on brain unenhanced CT: evaluation of its feasibility and assessment of the reliability of visual grading scales

Previous studies have evaluated intracranial internal carotid artery calcifications (ICACs) qualitatively using different visual grading scales, which could lead to inconsistent results. The purpose of this study was to evaluate the feasibility of ICAC volume measurement and to correlate the volume with visual grading scales. We included 49 patients (>50 years) who underwent unenhanced cranial CT. Two observers evaluated four visual grading scales and measured ICAC volumes semi-automatically, and interobserver agreements were assessed. Differences in ICAC volume between visual grades of each scale were tested. The relationship between the visual grading and volume was assessed. Interobserver agreements ranged from 0.841 to 0.901 for visual grading and 0.997 for volume measurement. Mean volumes were not significantly different between the visual grades (P > 0.05) except when comparing grade 4 with the other grades. The grades of each visual grading correlated well with ICAC volumes (Spearman's ρ = 0.849-0.881, P < 0.001). The relationship between the visual grades and volume was described by a quadratic model (R (2), 0.31-0.50, P < 0.01). ICAC volume measurement is feasible and reproducible, whereas visual grades poorly reflect the actual volume; therefore, volume measurement may be warranted for future research.

Intracranial Internal Carotid Artery Calcifications: Association with Vascular Risk Factors and Ischemic Cerebrovascular Disease

Intracranial Internal Carotid Artery Calcifications: Association with Vascular Risk Factors and Ischemic Cerebrovascular Disease

Intracranial Internal Carotid Artery Calcifications: Association with Vascular Risk Factors and Ischemic Cerebrovascular Disease

Atherosclerotic calcifications are present not only in the extracranial carotid bifurcation but also in the intracranial part of the internal carotid artery. We assessed the association between intracranial internal carotid artery calcifications and cardiovascular risk factors in patients with ischemic cerebrovascular disease and the association between calcifications and the presence of this disease. Patients undergoing multidetector CT (MDCT) angiography of the carotid arteries for assessment of stenosis degree were included in the study. A semiautomatic custom-made system to quantify calcifications was developed. The associations between the volume of calcifications and cardiovascular risk factors and the type of ischemic cerebrovascular symptoms were assessed with logistic regression. MDCT angiography was performed in 406 patients (age, 62 +/- 14 years; 242 men). Men had a significantly higher calcification volume (66 mm(3)) than women (33 mm(3)). Calcification volume was positively associated with age in both men and women. Smoking, hypercholesterolemia, and a history of cardiac disease were independently related to the presence of calcifications. A history of cardiac disease and ischemic cerebrovascular disease were independently related to the volume of calcifications. No association was found between calcifications and the presence or type of ischemic cerebrovascular disease in the vascular territory of the intracranial internal carotid artery. Calcifications were associated with higher age and male gender. The presence and volume of calcifications were independently associated with cardiovascular risk factors. Calcifications were not related to the presence or type of ischemic cerebrovascular disease.