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Berghout BP, Camarasa RY, Van Dam-Nolen DH, van der Lugt A, de Bruijne M, Koudstaal PJ, Ikram MK, Bos D. Burden of intracranial artery calcification in white patients with ischemic stroke. Eur Stroke J 2024:23969873241239787. [PMID: 38506452 DOI: 10.1177/23969873241239787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
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.
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Affiliation(s)
- Bernhard P Berghout
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robin Yr Camarasa
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dianne Hk Van Dam-Nolen
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marleen de Bruijne
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Peter J Koudstaal
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Daniel Bos
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
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Gozdalski J, Nowicki TK, Kwarciany M, Kowalczyk K, Narkiewicz K, Gasecki D. Aortic Stiffness Is Independently Associated with Intracranial Carotid Artery Calcification in Patients with Ischemic Stroke. Cerebrovasc Dis 2023; 53:216-223. [PMID: 37591226 DOI: 10.1159/000533510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/05/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION Intracranial carotid artery calcification (ICAC), as a strong contributor to the occurrence of ischemic stroke, might be present in the medial or intimal arterial layer. Traditional cardiovascular risk factors (CVRFs) are associated with ICAC; however, its association with new markers of vascular function is less understood. The paper aimed to evaluate the relationship between carotid-femoral pulse wave velocity (CF-PWV) and ICAC subtypes. METHODS We enrolled 65 patients with ischemic stroke. CF-PWV, systolic, diastolic, mean blood pressure, and pulse pressure were measured within 6 ± 2 days after stroke onset, and CT was performed within 24 h. ICAC on the stroke site was classified by two methods: volume and score based. Tertiles of ICAC volume were determined, and low-grade ICAC (T1) was regarded as a reference. According to the score-based method, (dominant) medial and (dominant) intimal ICAC subtypes were determined. Data were analyzed with multivariate logistic regression. RESULTS Medial and intimal ICAC subtypes were found in 34 (52%) and 24 (37%) patients, respectively. In 11% of patients, no ICAC calcifications were found. CF-PWV was higher in patients with high-grade ICAC (OR = 1.56, 95% CI = 1.03-2.35, p = 0.035). CF-PWV was higher in patients with the medial ICAC subtype (OR = 1.60, 95% CI = 1.00-2.55, p = 0.049) after adjustment for traditional CVRFs. CONCLUSION Our study demonstrates that among patients with ischemic stroke, aortic stiffness is independently associated with ICAC and that medial ICAC, compared with intimal ICAC, is accompanied by more advanced aortic stiffness.
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Affiliation(s)
| | - Tomasz K Nowicki
- Department of Adult Neurology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
- 2nd Department of Radiology, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | - Mariusz Kwarciany
- Department of Adult Neurology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Kamil Kowalczyk
- Department of Adult Neurology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Krzysztof Narkiewicz
- Division of Hypertension & Diabetology, Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Dariusz Gasecki
- Department of Adult Neurology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
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Li X, Du H, Li J, Chen X. Intracranial artery calcification as an independent predictor of ischemic stroke: a systematic review and a meta-analysis. BMC Neurol 2023; 23:21. [PMID: 36647035 PMCID: PMC9841662 DOI: 10.1186/s12883-023-03069-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/13/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND AND PURPOSE The association between intracranial artery calcification (IAC) and the risk of ischemic stroke occurrence or poor prognosis had not yet been fully understood. In this study, we conducted a meta-analysis of existing studies aimed to assess whether IAC can be used to predict future ischemic stroke and post-stroke mortality. METHODS Medline, Cochrane, Web of Science and Google Scholar databases were searched up to June 30, 2022. Studies were included if they reported risk ratio (RR) or odds ratios (OR) and corresponding 95% confidence intervals (CI) of stroke concerning the presence of IAC. Random or fixed effects model meta-analyses were performed. Meta-analysis was conducted by using Stata version 16.0. RESULTS Twelve studies involving 9346 participants were included. Compared with those without IAC, patients with IAC had a higher risk of stroke occurrence (adjusted OR 1.62, 95% CI 1.18-2.23, P = 0.001) and stroke recurrence (adjusted OR 1.77, 95% CI 1.25-2.51, P = 0.003). However, we did not find a significant correlation between IAC and post-stroke mortality (pooled OR 1.12, 95% CI 0.80-1.56, P = 0.504). CONCLUSIONS Our meta-analysis demonstrated that the presence of IAC was identified as an independent risk factor for ischemic stroke occurrence and recurrence but is not a predictor of post-stroke mortality.
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Affiliation(s)
- Xuelong Li
- grid.16890.360000 0004 1764 6123Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Heng Du
- grid.16890.360000 0004 1764 6123Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Jia Li
- grid.33199.310000 0004 0368 7223Department of Neurology, Wuhan No.1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Xiangyan Chen
- grid.16890.360000 0004 1764 6123Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Fote GM, Raefsky S, Mock K, Chaudhari A, Shafie M, Yu W. Intracranial Arterial Calcifications: Potential Biomarkers of Stroke Risk and Outcome. Front Neurol 2022; 13:900579. [PMID: 36119671 PMCID: PMC9475140 DOI: 10.3389/fneur.2022.900579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/24/2022] [Indexed: 11/30/2022] Open
Abstract
Intracranial artery calcifications (IAC), a common and easily identifiable finding on computed tomorgraphy angiography (CTA), has gained recognition as a possible risk factor for ischemic stroke. While atherosclerosis of intracranial arteries is believed to be a mechanism that commonly contributes to ischemic stroke, and coronary artery calcification is well-established as a predictor of both myocardial infarction (MI) and ischemic stroke risk, IAC is not currently used as a prognostic tool for stroke risk or recurrence. This review examines the pathophysiology and prevalence of IAC, and current evidence suggesting that IAC may be a useful tool for prediction of stroke incidence, recurrence, and response to acute ischemic stroke therapy.
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Affiliation(s)
- Gianna M. Fote
- School of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Sophia Raefsky
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, United States
| | - Kelton Mock
- School of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Amit Chaudhari
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
- *Correspondence: Amit Chaudhari
| | - Mohammad Shafie
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Wengui Yu
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
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Kamtchum-Tatuene J, Mwandumba HC, Mwangalika Kachingwe G, Bonnett LJ, Kayange N, Solomon T, Benjamin LA. A cross-sectional feasibility study of neurovascular ultrasound in Malawian adults with acute stroke-like syndrome. PLoS One 2020; 15:e0229033. [PMID: 32032392 PMCID: PMC7006928 DOI: 10.1371/journal.pone.0229033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/28/2020] [Indexed: 01/25/2023] Open
Abstract
Background In sub-Saharan Africa, there is a dearth of epidemiologic data on the burden of cerebral atherosclerosis. This is explained by the limited availability and the high cost of standard vascular imaging techniques. Neurovascular ultrasound is portable, cheaper and non-invasive and could, therefore, represent a reasonable alternative to fill this knowledge gap. We explored the feasibility of neurovascular ultrasound in Malawian adults with acute stroke-like syndrome to inform the design of future large stroke studies comparing its diagnostic performance to that of gold standard vascular imaging techniques in sub-Saharan Africa. Methods We enrolled consecutive patients diagnosed with acute stroke-like syndrome based on the World Health Organization definition. Clinical and demographic data were recorded, and a comprehensive neurovascular ultrasound was performed. Fisher’s exact and Kruskal-Wallis tests were used to study the relationship between atherosclerosis and potential risk factors. Results Sixty-six patients were enrolled (mean age: 58.7 years). The frequency of extracranial atherosclerosis was 39.4% (n = 26, 95% CI: 28.6–52.2). There were 12 patients with abnormal carotid intima media thickness (18.2%, 95% CI: 9.8–29.6) and 14 patients with a carotid plaque (21.2%, 95% CI: 12.1–33.0). The frequency of intracranial atherosclerosis was 19.2% (95%CI: 6.6–39.4) in 26 patients with successful transcranial insonation. Hypertension (80.8 versus 52.5%, p = 0.03) and hypercholesterolemia (11.5 versus 0.0%, p = 0.05) were more prevalent in patients with extracranial atherosclerosis. Conclusions This study demonstrates the feasibility of neurovascular ultrasound to assess cervical arteries in adults with stroke-like syndrome in sub-Saharan Africa. There is a high rate of transcranial insonation failure in this setting, highlighting the need for echocontrast agents.
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Affiliation(s)
- Joseph Kamtchum-Tatuene
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- * E-mail:
| | - Henry C. Mwandumba
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, England, United Kingdom
| | - Gloria Mwangalika Kachingwe
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
| | - Laura J. Bonnett
- Department of Biostatistics, University of Liverpool, Liverpool, England, United Kingdom
| | - Noel Kayange
- Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Tom Solomon
- Institute of Infection and Global Health, University of Liverpool, Liverpool, England, United Kingdom
| | - Laura A. Benjamin
- Institute of Infection and Global Health, University of Liverpool, Liverpool, England, United Kingdom
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Association between Serum Gamma-glutamyl transferase and Intracranial Arterial Calcification in Acute Ischemic Stroke Subjects. Sci Rep 2019; 9:19998. [PMID: 31882831 PMCID: PMC6934471 DOI: 10.1038/s41598-019-56569-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/13/2019] [Indexed: 02/06/2023] Open
Abstract
Intracranial artery calcification (IAC) is an important risk factor for cerebral infarction and a key biomarker for intracranial artery stenosis. Gamma-glutamyl transferase (GGT) has been independently associated with increased cardiovascular events and coronary calcification. Our study assessed whether GGT is an independent factor for IAC in acute ischemic stroke (AIS) patients. This cross-sectional study involved a total of 754 patients with AIS (mean age: 65 ± 13.2 years). All the patients had received brain computed tomography angiography (CTA) examination to evaluate IAC. Further, serum GGT levels and other biochemical parameters were analyzed. The average GGT level in patients who died was also significantly increased (37.0 ± 26.8 vs 29.0 ± 21.5 U/L, p = 0.012). Partial correlation analysis showed that serum GGT levels were associated with NIHSS score at admission after adjustment for age and gender was considered (r = 0.150, p = 0.001). Logistic regression analysis showed that serum GGT levels independently predicted all-cause mortality (OR = 1.036, 95% CI: 1.014-1.060, p = 0.002), NIHSS scores (β = 0.051, 95% CI: 0.020-0.082, p = 0.001) and IAC scores (β = 0.006, 95% CI: 0.003-0.014, p = 0.005) in male patients. Each SD (standard deviation) increase of serum GGT levels was also associated with risk of all-cause mortality (OR = 2.272, 95% CI: 1.364-3.787, P = 0.002). GGT levels in patients with severe IAC were significantly elevated (37.6 ± 33.6 vs 28.6 ± 19.2, p < 0.001). However, serum GGT levels could not independently predict the severity of IAC in AIS patients. Our study identified that serum GGT levels were significantly elevated in patients who died, and the GGT levels had a certain association with the risk of death and IAC in male patients.
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Chang Z, Yan H, Zhen Y, Zheng J, Liu Z. Lower Limb Arterial Calcification and Acute Thrombosis Risk in Patients with Peripheral Artery Disease. Ann Vasc Surg 2019; 63:227-233. [PMID: 31536790 DOI: 10.1016/j.avsg.2019.06.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 06/18/2019] [Accepted: 06/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Calcification is closely related to in situ thrombosis secondary to plaque rupture in the coronary artery. However, the association between calcification in lower extremity arteries and acute thrombosis has not been assessed. We thus sought to determine whether lower limb arterial calcification (LLAC) was correlated with acute thrombosis in patients with symptomatic peripheral artery disease (PAD). METHODS We retrospectively reviewed consecutive patients presenting with symptomatic PAD between April 2017 and March 2018 who underwent lower extremity arterial evaluation by computed tomography (CT) angiography. Patient characteristics and cardiovascular risk factors were recorded, and LLAC scores were determined by noncontrast CT scans. Univariate and multivariate logistic regression was used to identify factors associated with acute thrombosis. RESULTS The record search identified 201 patients with symptomatic PAD, including 24 with acute thrombosis and 177 without. Patients in the acute thrombosis group were significantly younger (P = 0.04) and had less diabetes mellitus (P = 0.04). Patients with acute thrombosis had more advanced ischemia at presentation (P < 0.01) and higher amputation rate within 30 days (P < 0.01). Univariate regression showed a significant association among acute thrombosis and age, diabetes mellitus, and LLAC score; in multivariable analysis, only the LLAC score (odds ratio 0.60, 95% confidence interval 0.37-0.98) maintained an association with acute thrombosis after adjusting for relevant risk factors. CONCLUSIONS The LLAC score is independently and inversely associated with acute thrombosis in patients with PAD.
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Affiliation(s)
- Zhihui Chang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Hankun Yan
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Yanhua Zhen
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Jiahe Zheng
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Zhaoyu Liu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China.
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Zhang HX, Fan QX, Xue SZ, Zhang M, Zhao JX. Twenty-four-hour blood pressure variability plays a detrimental role in the neurological outcome of hemorrhagic stroke. J Int Med Res 2018; 46:2558-2568. [PMID: 29865917 PMCID: PMC6124278 DOI: 10.1177/0300060518760463] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Blood pressure variability (BPV) is a modifiable risk factor for stroke. This study was performed to determine the prognostic role of BPV in patients with acute hemorrhagic stroke. Methods The data of 131 hospitalized hypertensive patients with spontaneous intracerebral hemorrhage (sICH) were collected. All patients underwent examinations using several neurological scales (Glasgow Coma Scale, National Institutes of Health Stroke Scale, and modified Rankin scale [mRS]) and BP measurements at different time points. Results Sex, age, hematoma volume, and neurological scores were not significantly different between patients with a favorable and unfavorable prognosis for sICH. However, significant differences were found in hypertension, diabetes, metabolic syndrome, atrial fibrillation, smoking, and stroke history. The standard deviation (SD), coefficient of variation (CV), and maximum–minimum range (Max–Min) of diastolic BP and the mean, SD, CV, and Max–Min of systolic BP significantly differed between the groups. Statistical analysis also demonstrated correlations between the 90-day mRS score and BPV and between systolic BPV and the 90-day mRS score. Conclusion High systolic or diastolic BPV within 24 hours of hemorrhagic stroke onset is associated with the 90-day neurological prognosis. The 24-hour BPV plays a critical role in the neurological outcome of hemorrhagic stroke.
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Affiliation(s)
- Huan-Xin Zhang
- Department of Cardiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
| | - Qun-Xiong Fan
- Department of Cardiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
| | - Shi-Zhen Xue
- Department of Cardiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
| | - Min Zhang
- Department of Cardiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
| | - Ji-Xian Zhao
- Department of Cardiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
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