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1.
J Stroke Cerebrovasc Dis ; 33(9): 107873, 2024 Sep.
Article in English | MEDLINE | ID: mdl-39009197

ABSTRACT

OBJECTIVES: This study investigates the association between C-reactive protein (CRP) and ischemic stroke caused by large artery atherosclerosis (LAA). METHODS: Five Mendelian Randomization (MR) methodologies were used for two-sample analyses: Inverse Variance Weighting (IVW), MR-Egger regression, Weighted Median (WM), Simple Mode, and Weighted Mode. CRP exposure data were obtained from aggregated summary statistics from a meta-analysis of genome-wide association studies (GWAS) in individuals of European ancestry (n = 343,524; UK Biobank). Stroke data were used as the outcome, with specific dataset details for relevant subtypes (cases = 40,585, controls = 406,111). RESULTS: In the CRP GWAS dataset, selected single nucleotide polymorphisms (SNPs) as instrumental variables (IVs) showed genome-wide significance and a causal relationship with CRP, particularly in relation to LAA stroke. IVW indicated a robust causal connection between CRP and LAA stroke (Beta = 0.151, SE = 0.055, P = 0.006). The WM approach supported this relationship (Beta = 0.176, SE = 0.082, P = 0.033). However, MR-Egger regression suggested a potential absence of a causal link (Beta = 0.098, SE = 0.077, P = 0.206), with minimal influence from horizontal pleiotropy (Intercept = 0.0029; P = 0.317). The Simple mode found no significant association (Beta = 0.046, SE = 0.217, P = 0.834), while the Weighted mode revealed a significant causal association (Beta = 0.138, SE = 0.059, P = 0.020) between CRP and LAA stroke. CONCLUSIONS: MR analysis provides evidence for a potential causal relationship between CRP and an increased risk of LAA stroke.


Subject(s)
C-Reactive Protein , Genetic Predisposition to Disease , Genome-Wide Association Study , Ischemic Stroke , Polymorphism, Single Nucleotide , Humans , Biomarkers/blood , C-Reactive Protein/analysis , C-Reactive Protein/genetics , C-Reactive Protein/metabolism , Intracranial Arteriosclerosis/genetics , Intracranial Arteriosclerosis/blood , Intracranial Arteriosclerosis/epidemiology , Ischemic Stroke/genetics , Ischemic Stroke/blood , Ischemic Stroke/diagnosis , Ischemic Stroke/epidemiology , Mendelian Randomization Analysis , Phenotype , Risk Assessment , Risk Factors
2.
J Am Heart Assoc ; 13(13): e032938, 2024 Jul 02.
Article in English | MEDLINE | ID: mdl-38842273

ABSTRACT

BACKGROUND: The influence of burden of atherosclerosis in the brain supplying arteries on mortality in patients with acute ischemic stroke or transient ischemic attack is poorly known. We assessed whether total burden of atherosclerosis within cervicocerebral arteries is associated with long-term mortality. METHODS AND RESULTS: A total of 406 patients (median age, 71.8 years; 57.9% male) with acute ischemic stroke or transient ischemic attack were included and their cervicocerebral arteries imaged with computed tomography angiography. The presence of atherosclerotic findings was scored for 25 artery segments and points were summed as a Cervicocerebral Atherosclerosis Burden (CAB) score, analyzed as quartiles. Data on all-cause mortality came from Statistics Finland. After a median follow-up of 7.3 years, 147 (33.5%) patients had died. Compared with surviving patients, those who died had a higher median CAB score (5, interquartile range 2-10 versus 11, 7-16; P<0.001). Cumulative mortality increased from 8.9% (95% CI, 7.0-10.8) in the lowest to 61.4% (95% CI, 55.4-67.4) in the highest quartile of CAB score. Adjusted for demographics, cardiovascular risk factors, secondary preventive medication, and admission National Institute of Health Stroke Scale score, every CAB score point increased probability of death by 3%. Analyzed in quartiles, the highest CAB quartile was associated with a 2.5-fold likelihood of all-cause mortality. CONCLUSIONS: The main findings of our study were the increasing mortality with the total burden of computed tomography angiography-defined atherosclerosis in the brain supplying arteries after ischemic stroke or transient ischemic attack and that the CAB score-integrating this pathology-independently increased all-cause mortality.


Subject(s)
Computed Tomography Angiography , Ischemic Attack, Transient , Ischemic Stroke , Humans , Male , Female , Aged , Ischemic Attack, Transient/mortality , Ischemic Attack, Transient/epidemiology , Ischemic Stroke/mortality , Ischemic Stroke/epidemiology , Finland/epidemiology , Risk Factors , Aged, 80 and over , Middle Aged , Time Factors , Risk Assessment , Intracranial Arteriosclerosis/diagnostic imaging , Intracranial Arteriosclerosis/mortality , Intracranial Arteriosclerosis/complications , Intracranial Arteriosclerosis/epidemiology , Prognosis , Cerebral Angiography
3.
J Stroke Cerebrovasc Dis ; 33(8): 107782, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38777218

ABSTRACT

BACKGROUND AND PURPOSE: Atherosclerotic burden increases the risk of both extracranial internal carotid artery stenosis (ICS) and intracranial large artery disease (ICAD). However, the differences in risk profiles have not been thoroughly investigated. METHODS: Participants were recruited from the Nagahama study cohort in Japan. Individuals over 60 years old who underwent 1.5-T head and neck magnetic resonance angiography (MRA) between July 2013 and February 2017 were included. ICAD was defined as WASID ≥ 50 %, and ICS was defined as NSCET ≥ 30 %. The prevalence and association of risk factors, including proatherogenic and proinflammatory factors, and the p.R4810K variant in the RNF213 gene, were investigated. Multivariable logistic regression analyses were performed. RESULTS: A total of 3089 individuals participated in the study, with a mean age of 68.1 ± 5.3 years, and 36.0 % were males. Among them, 52 (1.7 %) had ICS, 119 (3.8 %) had ICAD, and 15 (0.49 %) had both conditions. Alopecia areata was an independent predictor for both ICS (Odds ratio [OR] 3.5; 95 % CI 1.3-8.3) and ICAD (OR 2.1; 95 % CI 1.0-3.9). Diabetes (OR 3.7; 95 % CI 2.0-7.0) and older age (OR 2.4; 95 % CI 1.2-4.5) were associated only with ICS, while the RNF213 variant was associated with only ICAD (OR 5.7; 95 % CI 1.6-16.0). ICS and ICAD were also independently associated with each other. CONCLUSIONS: In this MRA-based large scale study, alopecia areata, known as a systemic inflammatory disease, was shown to be a common risk factor for ICS and ICAD. While conventional atherosclerotic factors were associated with ICS, non-atherosclerotic factors appear to contribute to ICAD in Japan.


Subject(s)
Asymptomatic Diseases , Carotid Stenosis , Intracranial Arteriosclerosis , Magnetic Resonance Angiography , Ubiquitin-Protein Ligases , Humans , Male , Female , Aged , Risk Factors , Japan/epidemiology , Intracranial Arteriosclerosis/epidemiology , Intracranial Arteriosclerosis/diagnostic imaging , Intracranial Arteriosclerosis/genetics , Middle Aged , Ubiquitin-Protein Ligases/genetics , Prevalence , Risk Assessment , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/epidemiology , Carotid Stenosis/genetics , Adenosine Triphosphatases/genetics , Genetic Predisposition to Disease , Phenotype
4.
Int J Obes (Lond) ; 48(8): 1103-1109, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38637718

ABSTRACT

BACKGROUND: Obesity and metabolic syndrome (MetS) have been acknowledged to commonly co-exist and lead to increased risks of stroke, whereas the association between various BMI-based metabolic phenotypes and development of intracranial atherosclerotic stenosis (ICAS) remained controversial. METHODS: A total of 5355 participants were included from the Asymptomatic Polyvascular Abnormalities Community (APAC) study. Participants were categorized into six groups according to their body mass index (BMI) and MetS status. ICAS was assessed using transcranial Doppler (TCD) Ultrasonography. Logistic regression was employed to evaluate the association between BMI-based metabolic phenotypes and ICAS. RESULTS: 704 participants were diagnosed with ICAS. Compared to the metabolic healthy normal weight (MH-NW) group, the metabolic unhealthy normal weight (MUH-NW) group demonstrated a higher risk of ICAS (full-adjusted odds ratio [OR], 1.91; 95% confidence interval [CI], 1.42-2.57), while no significant association was observed in the metabolic unhealthy obesity (MUO) group (full-adjusted OR, 1.07; 95% CI, 0.70-1.65) and other metabolic healthy groups regardless of BMI. The results were consistent across gender, age, smoking, alcohol intake, and physical activity subgroups. CONCLUSION: The present study suggested that MUH-NW individuals had a significant association with increased risk of ICAS compared with MH-NW individuals.


Subject(s)
Body Mass Index , Intracranial Arteriosclerosis , Metabolic Syndrome , Phenotype , Humans , Male , Female , Cross-Sectional Studies , Middle Aged , Intracranial Arteriosclerosis/epidemiology , Prevalence , Metabolic Syndrome/epidemiology , Aged , Obesity/epidemiology , Obesity/complications , Risk Factors , Adult , Ultrasonography, Doppler, Transcranial
5.
Eur Stroke J ; 9(3): 743-750, 2024 Sep.
Article in English | MEDLINE | ID: mdl-38506452

ABSTRACT

INTRODUCTION: The diagnostic workup of stroke doesn't identify an underlying cause in two-fifths of ischemic strokes. Intracranial arteriosclerosis is acknowledged as a cause of stroke in Asian and Black populations, but is underappreciated as such in whites. We explored the burden of Intracranial Artery Calcification (IAC), a marker of intracranial arteriosclerosis, as a potential cause of stroke among white patients with recent ischemic stroke or TIA. PATIENTS AND METHODS: Between December 2005 and October 2010, 943 patients (mean age 63.8 (SD ± 14.0) years, 47.9% female) were recruited, of whom 561 had ischemic stroke and 382 a TIA. CT-angiography was conducted according to stroke analysis protocols. The burden of IAC was quantified on these images, whereafter we assessed the presence of IAC per TOAST etiology underlying the stroke and assessed associations between IAC burden, symptom severity, and short-term functional outcome. RESULTS: IAC was present in 62.4% of patients. Furthermore, IAC was seen in 84.8% of atherosclerotic strokes, and also in the majority of strokes with an undetermined etiology (58.5%). Additionally, patients with larger IAC burden presented with heavier symptoms (adjusted OR 1.56 (95% CI [1.06-2.29]), but there was no difference in short-term functional outcome (1.14 [0.80-1.61]). CONCLUSION: IAC is seen in the majority of white ischemic stroke patients, aligning with findings from patient studies in other ethnicities. Furthermore, over half of patients with a stroke of undetermined etiology presented with IAC. Assessing IAC burden may help identify the cause in ischemic stroke of undetermined etiology, and could offer important prognostic information.


Subject(s)
Ischemic Stroke , White People , Humans , Female , Male , Middle Aged , Ischemic Stroke/epidemiology , Ischemic Stroke/ethnology , Ischemic Stroke/etiology , Aged , White People/statistics & numerical data , Vascular Calcification/epidemiology , Vascular Calcification/diagnostic imaging , Vascular Calcification/ethnology , Vascular Calcification/complications , Intracranial Arteriosclerosis/epidemiology , Intracranial Arteriosclerosis/diagnostic imaging , Intracranial Arteriosclerosis/ethnology , Intracranial Arteriosclerosis/complications , Computed Tomography Angiography , Intracranial Arterial Diseases/epidemiology , Intracranial Arterial Diseases/diagnostic imaging , Intracranial Arterial Diseases/complications
6.
J Neurol Sci ; 456: 122838, 2024 01 15.
Article in English | MEDLINE | ID: mdl-38171070

ABSTRACT

BACKGROUND: Intracranial atherosclerotic stenosis (ICAS) can cause either transient ischemic attack (TIA) or acute ischemic stroke (AIS). Pathogenesis of ICAS-AIS can be divided into artery-to-artery embolism(A-A), hypoperfusion(HP), and parent-artery atherosclerosis occluding penetrating artery(POPA). However, the prognosis of each type remains uncertain. Our study aimed to investigate potential disparities in the recurrent risk among these four subtypes of symptomatic ICAS. METHODS: From a prospective, single-center cohort study of acute cerebrovascular diseases from January 2017 to November 2021, we recruited 120 ICAS patients and classified them into four groups based on diffusion weighted imaging. Patients were retrospectively followed up for recurrence in December 2022. The primary outcome was recurrent cerebral vascular events (RCVE) in the same territory. RESULTS: Among 120 recruited patients, POPA(33%) was the most common subtype, followed by A-A(32%), HP(29%), and TIA(6%). Cumulative recurrent rate was 31.2% with median months of follow-up as 27(20-45.5). There was no significant difference in the risk of RCVE in the same territory among four subgroups within three months. However, when considering the risk after three months, TIA(57%) had the highest risk of RCVE, followed by A-A(26%), while HP(4%) and POPA(8%) had lower risks (P = 0.001). Cox regression model indicated that symptom and pathogenesis was an independent risk factor for RCVE in long-term prognosis (P = 0.022), after adjusting for a history of hypertension and cerebral infarction. CONCLUSIONS: Distinctive symptoms and pathogenesis of ICAS exhibit varying risks of RCVE in long-term prognosis. The differentiation in recurrent risk may provide valuable insights for guiding secondary prevention strategies.


Subject(s)
Intracranial Arteriosclerosis , Ischemic Attack, Transient , Ischemic Stroke , Stroke , Humans , Ischemic Attack, Transient/complications , Ischemic Attack, Transient/diagnostic imaging , Ischemic Attack, Transient/epidemiology , Cohort Studies , Prospective Studies , Retrospective Studies , Constriction, Pathologic/diagnostic imaging , Constriction, Pathologic/complications , Stroke/diagnostic imaging , Stroke/epidemiology , Stroke/etiology , Risk Factors , Intracranial Arteriosclerosis/complications , Intracranial Arteriosclerosis/diagnostic imaging , Intracranial Arteriosclerosis/epidemiology , Recurrence
8.
Cerebrovasc Dis ; 53(1): 28-37, 2024.
Article in English | MEDLINE | ID: mdl-37121226

ABSTRACT

INTRODUCTION: Periodontal disease (PD) and dental caries are oral infections leading to tooth loss that are associated with atherosclerosis and cerebrovascular disease. We assessed the hypothesis that PD and caries are associated with asymptomatic intracranial atherosclerosis (ICAS) in the Atherosclerosis Risk in Communities (ARIC) study. METHODS: Full-mouth clinical periodontal measurements (7 indices) collected at 6 sites per tooth from 6,155 subjects from the Dental Atherosclerosis Risk in Communities Study (DARIC) without prior stroke were used to differentiate seven PD stages (Periodontal Profile Class [PPC]-I to -VII) and dental caries on coronal dental surface (DS) and dental root surface (DRS). A stratified subset underwent 3D time-of-flight MR angiogram and 3D high isotropic-resolution black blood MRI. ICAS was graded according to the criteria established by the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial. We evaluated the relationship between PD stage and dental caries with asymptomatic ICAS, graded as no ICAS, <50% ICAS, and ≥50% ICAS. RESULTS: Among dentate subjects who underwent vascular imaging, 801 (70%) had no ICAS, 232 (20%) had <50% ICAS, and 112 (10%) had ≥50% ICAS. Compared to participants without gum disease (PPC-I), participants with mild-moderate tooth loss (PPC-VI), severe tooth loss (PPC-VII), and severe PD (PPC-IV) had higher odds of having <50% ICAS. Participants with extensive gingivitis (PPC-V) had significantly higher odds of having ≥50% ICAS. This association remained significant after adjusting for confounding variables: age, gender, race, hypertension, diabetes, dyslipidemia, 3-level education, and smoking status. There was no association between dental caries (DS and DRS) and ICAS <50% and ≥50%. CONCLUSION: We report significant associations between mild-moderate tooth loss, severe tooth loss, and severe PD with <50% ICAS as well as an association between extensive gingivitis and ≥50% ICAS. We did not find an association between dental caries and ICAS.


Subject(s)
Atherosclerosis , Dental Caries , Gingivitis , Intracranial Arteriosclerosis , Tooth Loss , Humans , Constriction, Pathologic/complications , Tooth Loss/epidemiology , Tooth Loss/complications , Dental Caries/diagnostic imaging , Dental Caries/epidemiology , Dental Caries/complications , Risk Factors , Atherosclerosis/complications , Gingivitis/epidemiology , Gingivitis/complications , Intracranial Arteriosclerosis/complications , Intracranial Arteriosclerosis/diagnostic imaging , Intracranial Arteriosclerosis/epidemiology
9.
J Stroke Cerebrovasc Dis ; 33(1): 107477, 2024 Jan.
Article in English | MEDLINE | ID: mdl-37966097

ABSTRACT

OBJECTIVES: Previous studies suggest an association between central arterial stiffness (CAS) and intracranial atherosclerotic disease (ICAD) among Asian participants with stroke or hypertension; this association has not been evaluated in United States populations. We assessed the cross-sectional association of CAS with ICAD presence and burden in late-life, and differences in association by age, sex, and race. MATERIALS AND METHODS: We conducted a cross-sectional analysis of 1,285 Atherosclerosis Risk in Communities Study participants [mean age 75 (standard deviation: 5) years, 38 % male, 20  % Black] at Visit 5 (2011-2013). CAS was measured as carotid-femoral pulse wave velocity (cfPWV) using the Omron VP-1000 Plus. ICAD was assessed using high-resolution vessel wall MRI and MR angiography. We evaluated associations of a 1 standard deviation (SD) cfPWV (3.02 m/s) and high vs. non-high cfPWV (≥ 13.57 m/s vs. < 13.57 m/s) with presence of plaques (yes/no) and plaque number (0, 1-2, and >2) using multivariable logistic and ordinal logistic regression models adjusted for covariates. RESULTS: Each one SD greater cfPWV was associated with higher odds of plaque presence (odds ratio (OR)=1.32, 95 % confidence interval (CI): 1.22, 1.43), and an incrementally higher odds of number of plaques (OR 1-2 vs. 0 plaques = 1.21, 95 % CI: 1.10, 1.33; OR >2 vs. 0 plaques = 1.51, 95 % CI: 1.33,1.71). Results suggested differences by race, with greater magnitude associations among Black participants. CONCLUSIONS: CAS was positively associated with ICAD presence and burden; cfPWV may be a useful subclinical vascular measure for identification of individuals who are at high risk for cerebrovascular disease.


Subject(s)
Atherosclerosis , Intracranial Arteriosclerosis , Plaque, Atherosclerotic , Vascular Stiffness , Humans , Male , United States/epidemiology , Aged , Female , Risk Factors , Pulse Wave Analysis/methods , Cross-Sectional Studies , Atherosclerosis/diagnostic imaging , Atherosclerosis/epidemiology , Intracranial Arteriosclerosis/complications , Intracranial Arteriosclerosis/diagnostic imaging , Intracranial Arteriosclerosis/epidemiology
10.
Discov Med ; 35(179): 1015-1025, 2023 Dec.
Article in English | MEDLINE | ID: mdl-38058066

ABSTRACT

BACKGROUND: This study aims to determine how atherosclerotic plaque prevalence and characteristics vary between individuals residing year-round at middle and high altitudes who have intracranial atherosclerotic disease. METHODS: We conducted a retrospective analysis of patient data from our hospital, focusing on individuals with cerebrovascular symptoms who underwent high-resolution vessel wall imaging (HR-VWI). Patients who had lived at an altitude of <2500 meters for an extended period were classified in group A (n = 91), while those residing at an altitude of ≥2500 meters were placed in group B (n = 75). We examined the differences in plaque prevalence and characteristics between these two groups. RESULTS: The detection rate of basilar artery plaque was higher in group A compared to group B (16% vs. 7.6%, p = 0.036). Conversely, the detection rate of anterior cerebral artery plaque was significantly lower in group A than in group B (4% vs. 11.8%, p = 0.016). The eccentricity index (EI) was greater in group B than in group A (0.72 ± 0.11 vs. 0.68 ± 0.12, p = 0.012). The prevalence of intraplaque hemorrhage (IPH) was lower in group B than in group A (39.5% vs. 58.7%, p = 0.002). CONCLUSIONS: IPH prevalence was lower in patients residing at high altitudes than in those residing at middle altitudes. However, patients living at high altitudes had a higher EI compared to those residing at middle altitudes. These findings underscore the presence of disparities in the prevalence and characteristics of intracranial atherosclerotic plaques between individuals residing at medium and high altitudes. It is essential to account for these distinctions when diagnosing plaques.


Subject(s)
Intracranial Arteriosclerosis , Plaque, Atherosclerotic , Humans , Plaque, Atherosclerotic/diagnostic imaging , Plaque, Atherosclerotic/epidemiology , Altitude , Magnetic Resonance Imaging/methods , Prevalence , Retrospective Studies , Hemorrhage , Intracranial Arteriosclerosis/epidemiology
11.
Clin Neurol Neurosurg ; 235: 108024, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37922680

ABSTRACT

OBJECTIVE: To directly compare the 90-day outcomes of patients with symptomatic intracranial atherosclerotic disease (ICAD), extracranial carotid atherosclerotic disease (ECAD), and ICAD with concomitant ECAD. METHODS: From 2017-2021, patients who had (1) a transient ischemic attack or ischemic stroke within 30 days of admission as evaluated by a stroke neurologist and (2) ipsilateral ICAD and/or ECAD were prospectively enrolled. The cohort was divided into three groups: ICAD, ECAD, and ICAD with concomitant ECAD. The primary outcome assessed was 90-day ischemic stroke recurrence. Secondary outcomes included 90-day myocardial infarction (MI), all-cause mortality, and major adverse cardiovascular events (MACE, including cardiovascular death, nonfatal MI, and/or nonfatal ischemic stroke). RESULTS: Of 371 patients included in the analysis, 240 (64.7%) patients had ICAD only, 93 (25.0%) patients had ECAD only, and 38 (10.3%) patients had ICAD with concomitant ECAD. On multivariate time-to-event analysis adjusting for potential confounders and with ICAD as the reference comparator, the risk of 90-day clinical outcomes was highest among patients with ICAD and concomitant ECAD, with adjusted hazard ratios of 4.54 (95% CI=1.45, 14.2; p = 0.006), 9.32 (95% CI=1.58, 54.8; p = 0.014), and 8.52 (95% CI=3.54, 20.5; p < 0.001) for 90-day ischemic stroke, MI, and MACE, respectively. CONCLUSIONS: Patients with ICAD and concomitant ECAD have a poorer prognosis and are at significantly higher risk for 90-day ischemic stroke, MI, and MACE. Further research should focus on the evaluation of coronary atherosclerotic disease and more intensive medical therapy in this population.


Subject(s)
Atherosclerosis , Carotid Artery Diseases , Intracranial Arteriosclerosis , Ischemic Attack, Transient , Ischemic Stroke , Myocardial Infarction , Stroke , Humans , Prospective Studies , Atherosclerosis/complications , Stroke/complications , Myocardial Infarction/epidemiology , Carotid Artery Diseases/complications , Carotid Artery Diseases/surgery , Carotid Artery Diseases/epidemiology , Ischemic Attack, Transient/epidemiology , Ischemic Attack, Transient/complications , Ischemic Stroke/complications , Intracranial Arteriosclerosis/epidemiology , Risk Factors
12.
J Stroke Cerebrovasc Dis ; 32(12): 107399, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37866296

ABSTRACT

BACKGROUND: Data on prevalence of intracranial artery stenosis (ICAS) in Western populations is sparse. The aim of the study was to assess the prevalence and risk factors for ICAS in a mainly Caucasian general population. METHODS: We assessed the prevalence of ICAS in 1847 men and women aged 40 to 84 years who participated in a cross-sectional population-based study, using 3-dimensional time-of-flight 3 Tesla magnetic resonance angiography. ICAS was defined as a focal luminal flow diameter reduction of ≥50 %. The association between cardiovascular risk factor levels and ICAS was assessed by multivariable regression analysis. RESULTS: The overall prevalence of ICAS was 6.0 % (95 % confidence interval (CI) 5.0-7.2), 4.3 % (95 % CI 3.1-5.7) in women and 8.0 % (95 % CI 6.3-10.0) in men. The prevalence increased by age from 0.8 % in 40-54 years age group to 15.2 % in the 75-84 years age group. The majority of stenoses was located to the internal carotid artery (52.2 %), followed by the posterior circulation (33.1 %), the middle cerebral artery (10.8 %) and the anterior cerebral artery (3.8 %). The risk of ICAS was independently associated with higher age, male sex, hypertension, hyperlipidemia, diabetes mellitus, current smoking and higher BMI. CONCLUSIONS: The prevalence of ICAS in a general population of Caucasians was relatively high and similar to the prevalence of extracranial internal carotid artery stenosis in previous population-based studies.


Subject(s)
Carotid Stenosis , Intracranial Arteriosclerosis , Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Magnetic Resonance Angiography , Constriction, Pathologic/epidemiology , Prevalence , Cross-Sectional Studies , Intracranial Arteriosclerosis/diagnostic imaging , Intracranial Arteriosclerosis/epidemiology , Risk Factors , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/epidemiology , Anterior Cerebral Artery
13.
Eur J Neurol ; 30(12): 3761-3771, 2023 12.
Article in English | MEDLINE | ID: mdl-37738517

ABSTRACT

BACKGROUND AND PURPOSE: Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke in China, but the prevalence and prognosis of asymptomatic ICAD detected using high-resolution magnetic resonance imaging (HR-MRI) is largely unknown. The aim of this study was to investigate the prevalence and prognosis in order to guide neurologists in interpreting ICAD detected on HR-MRI. METHODS: We included stroke-free participants from a community-based prospective cohort (Shunyi study participants) who underwent HR-MRI between July 2014 and April 2016. The participants were divided into two groups: those with or without ICAD (ICAD+ and ICAD- , respectively). ICAD included intracranial artery stenosis and non-stenotic plaque. The primary outcome was ischemic stroke. Cox proportional hazard models were used to evaluate the association between ICAD and event outcomes. RESULTS: A total of 1060 stroke-free participants evaluated by HR-MRI were included from the Shunyi study. The median age at HR-MRI was 56 years and 64.7% were female. The ICAD prevalence was 36.3% (n = 385). The ICAD+ group was older and had more cerebrovascular risk factors. The rates of ischemic stroke in the ICAD- and ICAD+ groups were 1.3% (n = 9) and 5.2% (n = 20), respectively, with a median follow-up time of 54 months. ICAD was associated with an increased risk of ischemic stroke in the unadjusted and adjusted Cox models, with hazard ratios of 4.12 (95% confidence interval [CI] 1.87-9.05) and 2.50 (95% CI 1.05-5.94), respectively. The greatest risk of an event outcome was observed in participants with ≥70% stenosis or occlusion. The features of high-risk plaques were also identified. CONCLUSIONS: We found that ICAD detected using HR-MRI increases the long-term risk of a first-ever ischemic stroke in a stroke-free population, suggesting that the current primary prevention protocol of stroke awaits further optimization.


Subject(s)
Intracranial Arteriosclerosis , Ischemic Stroke , Plaque, Atherosclerotic , Stroke , Humans , Female , Male , Constriction, Pathologic/pathology , Prevalence , Prospective Studies , Magnetic Resonance Imaging/methods , Stroke/diagnostic imaging , Stroke/epidemiology , Stroke/complications , Prognosis , Plaque, Atherosclerotic/complications , Ischemic Stroke/complications , Intracranial Arteriosclerosis/diagnostic imaging , Intracranial Arteriosclerosis/epidemiology
14.
J Stroke Cerebrovasc Dis ; 32(10): 107252, 2023 Oct.
Article in English | MEDLINE | ID: mdl-37634256

ABSTRACT

OBJECTIVES: Given Mediterranean-style diet (MeDi) reduces risk of cardiovascular events, we hypothesized MeDi may also be protective against intracranial large artery stenosis (ICAS), a common cause of stroke worldwide. METHODS: This cross-sectional study included stroke-free participants of the Northern Manhattan Study, a diverse population-based study of stroke risk factors. We represented MeDi continuously (range 0-8) based on enrollment food frequency questionnaires, excluding alcohol consumption. We evaluated ICAS both dichotomously at clinically relevant stenosis severities and continuously as a score (possible range 0-44), summated from stenosis severity scores of major intracranial arteries from time-of-flight magnetic resonance angiography. We used logistic or zero-inflated Poisson regression, adjusting for key confounders. RESULTS: Among 912 included participants (mean age 64±8 years, 59% female, 65% Hispanic, mean MeDi score 4±1.5), 5% and 8% of participants had ≥50% or ≥70% ICAS, respectively (score median [interquartile range]: 0 [0-2]). Increased MeDi score was inversely associated with ICAS, but did not reach statistical significance (≥50% stenosis odds ratio (OR) [95% confidence interval (CI)]: 0.89 [0.79-1.06]; ≥70% stenosis OR [95% CI]: 0.91 [0.74-1.13]; stenosis score ß-estimate [95% CI]: -0.02 [-0.06-0.01]). CONCLUSION: In this stroke-free subsample, we did not find a significant association between MeDi and ICAS. We may have been limited by statistical power.


Subject(s)
Diet, Mediterranean , Intracranial Arteriosclerosis , Stroke , Humans , Female , Middle Aged , Aged , Male , Cross-Sectional Studies , Constriction, Pathologic/complications , Stroke/etiology , Risk Factors , Arteries , Intracranial Arteriosclerosis/diagnostic imaging , Intracranial Arteriosclerosis/epidemiology , Intracranial Arteriosclerosis/complications
15.
J Stroke Cerebrovasc Dis ; 32(10): 107293, 2023 Oct.
Article in English | MEDLINE | ID: mdl-37604080

ABSTRACT

OBJECTIVE: To evaluate the association between remnant cholesterol (remnant-C) and intracranial atherosclerotic disease (ICAD) in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS). METHODS: We studied 1,564 participants with data on lipid profiles and high-resolution vessel wall MRI (VWMRI) from the ARIC-NCS. Remnant-C was computed as total cholesterol minus high-density lipoprotein cholesterol minus low-density lipoprotein cholesterol (LDL-C). The primary outcomes were the presence of intracranial plaques and luminal stenosis. Contributors were separated into four different groups based on remnant-C (22 mg/dL) and LDL-C (100 mg/dL) levels to investigate the function of remnant-C vs. LDL-C on ICAD. Multivariable logistic regression models were utilized to estimate the correlation among the discordant/concordant remnant-C and LDL-C, and ICAD. RESULTS: A total of 1,564 participants were included (age 76.2 ± 5.3). After multivariable adjustment, log remnant-C was correlated with greater ICAD risk [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.01 to 1.83]. The lower remnant-C/higher LDL-C group and the higher remnant-C/lower LDL-C group manifested a 1.53-fold (95% CI 1.06 to 2.20) and 1.52-fold (95% CI 1.08 to 2.14) greater risk of ICAD, relative to those having lower remnant-C/low LDL-C. Additionally, remnant-C ≥ 22 mg/dL distinguished participants at a greater risk of the presence of any stenosis compared to those at lower levels, even in participants with optimal levels of LDL-C. CONCLUSIONS: Elevated levels of remnant-C were connected to ICAD independent of LDL-C and traditional risk factors. The mechanisms of remnant-C association with ICAD probably offer insight into preventive risk-factor of ischemic stroke.


Subject(s)
Atherosclerosis , Intracranial Arteriosclerosis , Humans , Aged , Aged, 80 and over , Cholesterol, LDL , Constriction, Pathologic , Cholesterol , Risk Factors , Atherosclerosis/diagnostic imaging , Atherosclerosis/epidemiology , Intracranial Arteriosclerosis/diagnostic imaging , Intracranial Arteriosclerosis/epidemiology
16.
Eur J Neurol ; 30(9): 2700-2712, 2023 09.
Article in English | MEDLINE | ID: mdl-37294661

ABSTRACT

BACKGROUND AND PURPOSE: The purpose of this study was to explore the relationship between intracranial atherosclerosis and cerebral small vessel disease (CSVD). METHODS: Community-dwelling residents of Lishui, China in the PRECISE (Polyvascular Evaluation for Cognitive Impairment and Vascular Events) study were involved. Intracranial atherosclerosis was grouped by the severity of intracranial artery plaques with stenosis and burden. Four imaging markers including lacunes, white matter hyperintensity (WMH), cerebral microbleeds (CMBs), and perivascular spaces (PVS) as well as the CSVD burden scores were assessed. Logistic regression or ordinal logistic regression models with odds ratio (OR) or common OR (cOR) were used to estimate the relationship between intracranial atherosclerosis and CSVD markers and burdens. RESULTS: The mean age was 61.20 ± 6.68 years, and 1424 (46.52%) were men among 3061 participants included at baseline. Intracranial atherosclerotic burden was associated with the severity of the lacunes (OR = 4.18, 95% confidence interval [CI] = 1.83-9.58), modified WMH burden (cOR = 1.94, 95% CI = 1.01-3.71), presence of CMBs (OR = 2.28, 95% CI = 1.05-4.94), and CMB burden (OR = 2.23, 95% CI = 1.03-4.80). However, it was not associated with the WMH burden and PVS. Intracranial atherosclerotic burden was associated with CSVD burden (Wardlaw: cOR = 2.73, 95% CI = 1.48-5.05; Rothwell: cOR = 2.70, 95% CI = 1.47-4.95). The association between intracranial atherosclerosis and CSVD was obvious in participants with both anterior and posterior circulation artery stenosis. CONCLUSIONS: Based on a Chinese community population, there may be an association between intracranial atherosclerosis and CSVD, but its mechanism in relation to vascular risk factors still needs to be clarified.


Subject(s)
Cerebral Small Vessel Diseases , Intracranial Arteriosclerosis , Male , Humans , Middle Aged , Aged , Female , Magnetic Resonance Imaging , Constriction, Pathologic , Risk Factors , Cerebral Small Vessel Diseases/complications , Cerebral Small Vessel Diseases/diagnostic imaging , Cerebral Small Vessel Diseases/epidemiology , Intracranial Arteriosclerosis/complications , Intracranial Arteriosclerosis/diagnostic imaging , Intracranial Arteriosclerosis/epidemiology
17.
J Stroke Cerebrovasc Dis ; 32(8): 107212, 2023 Aug.
Article in English | MEDLINE | ID: mdl-37331251

ABSTRACT

BACKGROUND: Intracranial arterial dissection (ICAD) and intracranial atherosclerotic stenosis (ICAS) are often difficult to differentiate, and studies on their background factors and prognosis are scarce. Information on prognosis, including recurrence, is necessary for stroke care, and clarification of epidemiological and clinical differences between the two diseases is important for appropriately handling their heterogeneity. This study aimed to determine the association of ICAD and ICAS with in-hospital recurrence and prognosis and compare their background and clinical findings. METHODS: In this multicenter cohort study, we retrospectively analyzed data from the Saiseikai Stroke Database. Adults with ischemic stroke caused by ICAD or ICAS were included in this study. Patients' backgrounds and clinical findings were compared between the ICAD and ICAS groups. The outcome showed an association of ICAD with in-hospital recurrence of ischemic stroke and poor functional outcome relative to ICAS. Multivariable logistic regression analyses were performed to calculate the adjusted odds ratios (ORs) for ICAD with 95% confidence intervals (CIs) for each outcome. RESULTS: Among 15,622 patients registered in the Saiseikai Stroke Database, 2,020 were enrolled (ICAD group: 89; ICAS group: 1,931). In the ICAD group, 65.2% of the patients were aged <64 years. Vascular lesion location was more common in ICAD with the vertebral artery [42 (47.2%)], anterior cerebral artery [20 (22.5%)], and middle cerebral artery (MCA) [16 (18.0%)], and in ICAS with MCA 1046 (52.3%). Multivariable logistic regression analyses of the association between ICAD and in-hospital recurrence and poor functional outcome yielded a crude OR (95% CI) of 3.26 (1.06-9.97) and 0.97 (0.54-1.74), respectively, relative to ICAS. CONCLUSION: ICAD was associated with a higher in-hospital recurrence than ICAS; however, there was no significant difference in prognosis between the two groups. Differences in background characteristics and vessel lesions may be of interest in these two diseases.


Subject(s)
Aortic Dissection , Dissection, Blood Vessel , Intracranial Arteriosclerosis , Ischemic Stroke , Stroke , Adult , Humans , Ischemic Stroke/diagnostic imaging , Ischemic Stroke/therapy , Retrospective Studies , Cohort Studies , Stroke/diagnostic imaging , Stroke/therapy , Registries , Intracranial Arteriosclerosis/complications , Intracranial Arteriosclerosis/diagnostic imaging , Intracranial Arteriosclerosis/epidemiology , Aortic Dissection/complications , Aortic Dissection/diagnostic imaging , Aortic Dissection/therapy , Hospitals , Risk Factors
18.
Stroke ; 54(6): 1484-1493, 2023 06.
Article in English | MEDLINE | ID: mdl-37139814

ABSTRACT

BACKGROUND: Coexistence of intracranial atherosclerotic stenosis (ICAS) and unruptured intracranial aneurysms (UIAs) is increasingly encountered in clinical practice. This study aims to determine the prevalence of ICAS in patients with UIAs and procedural ischemic risk associated with ICAS when treating UIAs. METHODS: Based on the CAIASA study (Coexistence of Atherosclerotic Intracranial Arterial Stenosis With Intracranial Aneurysms), we prospectively included patients undergoing treatment procedures for UIAs from October 2015 to December 2020 at Beijing Tiantan Hospital, China. We used computed tomography angiography or digital subtraction angiography to diagnose ICAS (stenosis≥50%). Multivariable logistic regression and propensity-score matching were performed to evaluate the risk of procedure-related ischemic stroke and unfavorable outcome associated with ICAS. The ICAS score was used to explore the association between different burden of ICAS and procedure-related ischemic risk. RESULTS: Among 3949 patients who underwent endovascular or open surgical procedures for UIAs, 245 (6.2%) had ICAS. After exclusion, 15.7% (32/204) of patients with ICAS experienced procedure-related ischemic stroke compared with 5.0% (141/2825) of patients without ICAS. From the unmatched and matched cohort, ICAS was significantly associated with increased risk of procedure-related ischemic stroke (unmatched: adjusted odds ratio=3.11 [1.89-5.11]; and matched: adjusted odds ratio=2.99 [1.38-6.48]). This association became more evident among patients not receiving antiplatelet therapy (Pinteraction=0.022). For patients undergoing different treatment modalities, similar increased risks were observed (clipping: adjusted odds ratio=3.43 [1.73-6.79]; and coiling: adjusted odds ratio=3.59 [1.94-6.65]). Higher ICAS score was correlated with higher procedural ischemic risk (Ptrend<0.001). CONCLUSIONS: The occurrence of ICAS is not infrequent in patients with UIAs. ICAS confers an ~2-fold increased procedural ischemic risk, irrespective of clipping or coiling. Previous antiplatelet therapy may decrease the risk. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02795078.


Subject(s)
Intracranial Aneurysm , Intracranial Arteriosclerosis , Ischemic Stroke , Humans , Constriction, Pathologic/diagnostic imaging , Constriction, Pathologic/epidemiology , Constriction, Pathologic/complications , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/epidemiology , Intracranial Aneurysm/surgery , Intracranial Arteriosclerosis/diagnostic imaging , Intracranial Arteriosclerosis/epidemiology , Intracranial Arteriosclerosis/complications , Ischemic Stroke/complications , Platelet Aggregation Inhibitors/therapeutic use , Prevalence , Risk Factors
19.
Neurologist ; 28(5): 300-303, 2023 Sep 01.
Article in English | MEDLINE | ID: mdl-37083844

ABSTRACT

BACKGROUND: It is unknown whether plasma low-density lipoprotein-cholesterol level (LDL-C) can predict the occurrence of intracranial atherosclerotic stenosis (ICAS), especially asymptomatic (A)ICAS. This study investigated whether LDL-C level is independently associated with AICAS. METHODS: The Asymptomatic Polyvascular Abnormalities Community study is an ongoing community-based, prospective, long-term follow-up observational study with 3387 participants. AICAS was diagnosed by transcranial Doppler ultrasonography. The participants were divided into 3 groups based on LDL-C level. Cox regression was used to evaluate the association between LDL-C level and incidence of AICAS. RESULTS: During 2 years of follow-up, 9.98% of participants were diagnosed with AICAS. The incidence of AICAS (person-years with 95% CI) was 4.99% (4.48%-5.50%). AICAS incidence did not increase with increasing LDL-C level. Compared with the <2.6 mmol/l subgroup, the incidence of asymptomatic ICAS was not significantly higher in the 2.6 to 3.4 and >3.4 mmol/l subgroups after adjusting for confounding factors (hazard ratio=0.95, 95% CI: 0.86-1.03 and hazard ratio=0.96, 95% CI: 0.84-1.10, respectively). CONCLUSIONS: LDL-C is not an independent predictor of AICAS incidence in the Chinese population.


Subject(s)
Intracranial Arteriosclerosis , Humans , Risk Factors , Constriction, Pathologic/diagnostic imaging , Constriction, Pathologic/epidemiology , Prospective Studies , Cholesterol, LDL , Intracranial Arteriosclerosis/diagnostic imaging , Intracranial Arteriosclerosis/epidemiology
20.
Cardiovasc Diabetol ; 22(1): 90, 2023 04 19.
Article in English | MEDLINE | ID: mdl-37076850

ABSTRACT

BACKGROUND: The triglyceride-glucose (TyG) index, a simple measure of insulin resistance, is associated with intracranial atherosclerosis (ICAS) and stroke. In hypertensive populations, this association may be pronounced. The aim was to investigate the relationship between TyG and symptomatic intracranial atherosclerosis (sICAS) and recurrence risk in ischemic stroke patients with hypertension. METHODS: This prospective, multicenter cohort study included patients with acute minor ischemic stroke with a preadmission diagnosis of hypertension from September 2019 to November 2021 with a 3-month follow-up. The presence of sICAS was determined by a combination of clinical manifestations, the location of the infarction, and the corresponding artery with moderate-to-severe stenosis. ICAS burden was determined by the degree and number of ICAS occurrences. Fasting blood glucose (FBG) and triglyceride (TG) were measured to calculate TyG. The main outcome was ischemic stroke recurrence during the 90-day follow-up. Multivariate regression models were used to explore the association of TyG, sICAS, and ICAS burden with stroke recurrence. RESULTS: There were 1281 patients with a mean age of 61.6 ± 11.6 years; 70.1% were male, and 26.4% were diagnosed with sICAS. There were 117 patients who experienced stroke recurrence during follow-up. Patients were categorized according to quartiles of TyG. After adjusting for confounders, the risk of sICAS was greater (OR 1.59, 95% CI 1.04-2.43, p = 0.033) and the risk of stroke recurrence was significantly higher (HR 2.02, 95% CI 1.07-3.84, p = 0.025) in the fourth TyG quartile than in the first quartile. The restricted cubic spline (RCS) plot revealed a linear relationship between TyG and sICAS, and the threshold value for TyG was 8.4. Patients were then dichotomized into low and high TyG groups by the threshold. Patients with high TyG combined with sICAS had a higher risk of recurrence (HR 2.54, 95% CI 1.39-4.65) than patients with low TyG without sICAS. An interaction effect on stroke recurrence between TyG and sICAS was found (p = 0.043). CONCLUSION: TyG is a significant risk factor for sICAS in hypertensive patients, and there is a synergistic effect of sICAS and higher TyG on ischemic stroke recurrence. TRIAL REGISTRATION NUMBER: The study was registered on 16 August 2019 at https://www.chictr.org.cn/showprojen.aspx?proj=41160 (No. ChiCTR1900025214).


Subject(s)
Hypertension , Intracranial Arteriosclerosis , Ischemic Stroke , Stroke , Humans , Male , Middle Aged , Aged , Female , Cohort Studies , Constriction, Pathologic , Prospective Studies , Stroke/diagnosis , Stroke/epidemiology , Arteries , Hypertension/diagnosis , Hypertension/epidemiology , Ischemic Stroke/diagnosis , Ischemic Stroke/epidemiology , Risk Factors , Glucose , Intracranial Arteriosclerosis/diagnostic imaging , Intracranial Arteriosclerosis/epidemiology , Triglycerides , Blood Glucose , Biomarkers
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