Asymptomatic coronary artery disease in ischaemic stroke survivors: A systematic review and meta-analysis

BACKGROUND

Ischaemic stroke and coronary artery disease share risk factors and stroke survivors experience a high rate of cardiac events. Recent work suggests a high burden of asymptomatic coronary artery disease (CAD) in ischaemic stroke survivors. Thus, we performed this systematic review and meta-analysis to A) estimate the prevalence of CAD in ischaemic stroke survivors without known CAD and B) evaluate the association between coronary atherosclerosis and future major adverse cardiovascular events (MACE) in stroke survivors.

PATIENTS AND METHODS

We conducted a systematic review and meta-analysis according to the PRISMA statement. We included studies investigating acute ischaemic stroke or transient ischaemic attack where participants underwent anatomical assessment of all coronary arteries. For objective B) we included studies that reported an association between coronary atherosclerosis and MACE. Two reviewers used the Newcastle-Ottawa Scale to assess risk of bias. We used random-effects modelling for our analyses.

RESULTS

We identified 2983 studies of which 17 were included. These studies had a total of 6862 participants between 2008 and 2022. The pooled prevalence of any coronary atherosclerosis was 66.8% (95% CI 57.2%-75.1%) with substantial heterogeneity (I2 = 95.2%). The pooled prevalence of obstructive (>50%) stenosis was 29.3% with substantial heterogeneity (I2 = 91%). High-risk coronary anatomy (triple vessel disease or left main stenosis) was found in 7.0% (95% CI 4%-12%) with high heterogeneity I2 = 72%. One study examined high-risk plaques and found a prevalence of 5.9%. Five studies reported the association of coronary atherosclerosis with future MACE. The presence of obstructive CAD confers a HR of 8.0 (95% CI 1.7-37.1, p = 0.007) for future MACE.

DISCUSSION AND CONCLUSIONS

Asymptomatic CAD is common in ischaemic stroke survivors. The presence and severity of asymptomatic CAD strongly associates with the risk of future MACE. Further evaluation of the benefits of routine coronary assessment in ischaemic stroke is warranted.

Neither Trimethylamine-N-Oxide nor Trimethyllysine Is Associated with Atherosclerosis: A Cross-Sectional Study in Older Japanese Adults

Recent evidence suggests that trimethylamine-N-oxide (TMAO), a metabolite of L-carnitine and choline, is linked to atherosclerosis and cardiovascular diseases. As TMAO content is very high in fish, we raised the following question: why do Japanese people, who consume lots of fish, show a low risk of atherosclerosis? To address this question, we investigated the effects of TMAO and other L-carnitine-related metabolites on carotid intima-media thickness (IMT). Participants were recruited from a small island and a mountainous region. Plasma L-carnitine, γ-butyrobetaine (γBB), TMAO, trimethyllysine (TML), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) levels were measured using liquid or gas chromatography-mass spectrometry. Plasma L-carnitine concentration was higher in men than in women. TMAO and TML were significantly higher in the residents of the island than in the mountainous people. In multiple linear regression analyses in all participants, TML showed a significant inverse association with max-IMT and plaque score (PS), whereas TMAO did not show any associations. In women, L-carnitine was positively associated with max-IMT and PS. TMAO was correlated with both EPA and DHA levels, implying that fish is a major dietary source of TMAO in Japanese people. Our study found that plasma TMAO was not an apparent risk factor for atherosclerosis in elderly Japanese people, whereas a low level of TML might be a potential risk. L-carnitine may be a marker for atherosclerosis in women.

Bioinformatic Analysis Revealed the Essential Regulatory Genes and Pathways of Early and Advanced Atherosclerotic Plaque in Humans

Atherosclerosis (AS) is a lipid-induced, chronic inflammatory, autoimmune disease affecting multiple arteries. Although much effort has been put into AS research in the past decades, it is still the leading cause of death worldwide. The complex genetic network regulation underlying the pathogenesis of AS still needs further investigation to provide effective targeted therapy for AS. We performed a bioinformatic microarray data analysis at different atherosclerotic plaque stages from the Gene Expression Omnibus database with accession numbers GSE43292 and GSE28829. Using gene set enrichment analysis, we further confirmed the immune-related pathways that play an important role in the development of AS. We are reporting, for the first time, that the metabolism of the three branched-chain amino acids (BCAAs; leucine, isoleucine, and valine) and short-chain fatty acids (SCFA; propanoate, and butanoate) are involved in the progression of AS using microarray data of atherosclerotic plaque tissue. Immune and muscle system-related pathways were further confirmed as highly regulated pathways during the development of AS using gene expression pattern analysis. Furthermore, we also identified four modules mainly involved in histone modification, immune-related processes, macroautophagy, and B cell activation with modular differential connectivity in the dataset of GSE43292, and three modules related to immune-related processes, B cell activation, and nuclear division in the dataset of GSE28829 also display modular differential connectivity based on the weighted gene co-expression network analysis. Finally, we identified eight key genes related to the pathways of immune and muscle system function as potential therapeutic biomarkers to distinguish patients with early or advanced stages in AS, and two of the eight genes were validated using the gene expression dataset from gene-deficient mice. The results of the current study will improve our understanding of the molecular mechanisms in the progression of AS. The key genes and pathways identified could be potential biomarkers or new drug targets for AS management.

Risk of a coronary event in patients after ischemic stroke or transient ischemic attack

Coronary artery disease (CAD) together with stroke are the leading causes of death worldwide, and together, they pre-sent a health and economic burden. Ischemic stroke survivors and patients who suffered transient ischemic attack (TIA) have a higher prevalence of coronary atherosclerosis, and they have a relatively high risk of myocardial infarcti-on and nonstroke vascular death. Pubmed was searched for studies focused on investigating coronary atherosclerosis in ischemic stroke survivors or patients who suffered TIA and their cardiovascular risk assessment. There were corona-ry plaques in 48%-70% of stroke survivors without a known history of CAD, and significant stenosis of at least one coronary artery can be found in 31% of these patients. CAD is a major cause of morbidity and mortality in stroke survivors. Detection and treatment of silent CAD may improve the long-term outcome and survival of these patients.

[Prevalence of coronary artery disease in stroke survivors in Parakou (Benin) in 2019]

Introduction

la coronaropathie serait fréquente chez les survivants d´accident vasculaire cérébral (AVC). L´objectif de l´étude était de déterminer la prévalence de la coronaropathie chez les survivants d´AVC suivis au Centre Hospitalier Universitaire Départemental Borgou-Alibori (CHUD-B/A).

Méthodes

il s´est agi d´une étude transversale menée du 1^er mars au 31 août 2019. Elle a inclus tous les patients victimes d´AVC, d´âge ≥ 18 ans, reçus dans l´unité de neurologie du CHUD-B/A entre janvier 2012 et juillet 2019, ayant survécu à la phase aiguë, et chez qui le consentement éclairé écrit ou celui d´un tuteur (patients sévèrement handicapés) a été obtenu. Un entretien individuel, des mesures anthropométriques, un examen physique, un électrocardiogramme et une revue du dossier médical ont été effectués. La présence de coronaropathie a été définie par un antécédent documenté, des anomalies ST/T et/ou Q évocatrices (critères de Minnesota) ou un questionnaire de dépistage de l´angine de poitrine positif. Les facteurs associés à la coronaropathie ont été recherchés par une régression logistique.

Résultats

un total de 101 patients était inclus avec un âge moyen de 57,2±10,5 ans. Le délai médian depuis la survenue de l´AVC était de 11 mois [2,0-23,5]. Les AVC ischémiques prédominaient (57,4%). La prévalence de la coronaropathie était estimée à 49,5%. Les facteurs associés à la coronaropathie étaient la non-scolarisation (p=0,036), l´obésité (p=0,036) et le tabagisme ancien (p=0,044).

Conclusion

cette étude montre une fréquence élevée de coronaropathie chez les survivants d´AVC. Il est important de dépister la coronaropathie dans cette cible afin d´optimiser la prise en charge.

Prevalence and predictors of coronary artery disease in patients undergoing carotid artery stenting

INTRODUCTION

A relationship between carotid stenosis and coronary arterial disease (CAD) is widely accepted; however, data on the exact prevalence of coronary disease in patients with severe carotid stenosis are lacking. Information on the prevalence and predictors of CAD among these patients could impact diagnostic and treatment approaches.

AIM

The primary aim of this study was to determine the prevalence of significant CAD among patients referred for carotid artery revascularization. The secondary objectives included characterizing the association between the level of advancement of carotid stenosis and the presence of CAD, and between atherosclerotic risk factors and the presence of CAD in patients with carotid stenosis, and also to determine whether there was a difference in the prevalence of CAD between patients with symptomatic versus asymptomatic carotid stenosis.

PATIENTS AND METHODS

We included 200 patients with severe carotid stenosis, of whom 77 (38.5%) had symptomatic stenosis. All patients underwent coronary angiography no more than 6 months before the scheduled carotid revascularization. Of the 200 total of patients, 192 underwent carotid stenting, six underwent carotid endarterectomy, and two were treated conservatively. CAD was defined as stenosis of at least 50% on recent coronary angiography or a history of previous percutaneous coronary intervention and/or coronary aortic bypass graft; the prevalence was 77.5% among our patients. There was no statistically significant difference in the prevalence of CAD between patients with unilateral versus bilateral carotid stenosis or contralateral carotid occlusion. The difference in the severity of coronary disease, which was given by the SYNTAX score, was not significant between these groups. Factors associated with the presence of CAD were male sex, a history of smoking, and global or regional wall motion disorder on echocardiography. We did not find any significant difference in the prevalence of CAD between patients with symptomatic versus asymptomatic carotid stenosis.

CONCLUSION

We observed a very high prevalence of concomitant CAD in patients with severe carotid stenosis. The results of our study suggest that routine preprocedural screening for CAD in patients with carotid artery stenosis could identify a large proportion of patients with silent CAD; whether treatment for CAD before carotid revascularization can prevent periprocedural myocardial infarction should be addressed in a randomized-controlled trial.

Mechanisms of Berberine for the Treatment of Atherosclerosis Based on Network Pharmacology

Atherosclerosis is a common metabolic disease characterized by lipid metabolic disorder. The processes of atherosclerosis include endothelial dysfunction, new endothelial layer formation, lipid sediment, foam cell formation, plaque formation, and plaque burst. Owing to the adverse effects of first-line medications, it is urgent to discover new medications to deal with atherosclerosis. Berberine is one of the most promising natural products derived from traditional Chinese medicine. However, the panoramic mechanism of berberine against atherosclerosis has not been discovered clearly. In this study, we used network pharmacology to investigate the interaction between berberine and atherosclerosis. We identified potential targets related to berberine and atherosclerosis from several databases. A total of 31 and 331 putative targets for berberine and atherosclerosis were identified, respectively. Then, we constructed berberine and atherosclerosis targets with PPI data. Berberine targets network with PPI data had 3204 nodes and 79437 edges. Atherosclerosis targets network with PPI data had 5451 nodes and 130891 edges. Furthermore, we merged the two PPI networks and obtained the core PPI network from the merged PPI network. The core PPI network had 132 nodes and 3339 edges. At last, we performed functional enrichment analyses including GO and KEGG pathway analysis in David database. GO analysis indicated that the biological processes were correlated with G1/S transition of mitotic cells cycle. KEGG pathway analysis found that the pathways directly associated with berberine against atherosclerosis were cell cycle, ubiquitin mediated proteolysis, MAPK signaling pathway, and PI3K-Akt signaling pathway. After combining the results in context with the available treatments for atherosclerosis, we considered that berberine inhibited inflammation and cell proliferation in the treatment of atherosclerosis. Our study provided a valid theoretical foundation for future research.

Predicting asymptomatic coronary artery stenosis by aortic arch plaque in acute ischemic cerebrovascular disease: beyond the cervicocephalic atherosclerosis?

Background:

Asymptomatic coronary artery stenosis (ACAS) ≥50% is common in patients with acute ischemic cerebrovascular disease (AICVD), which portends a poor cardiovascular and cerebrovascular prognosis. Identifying ACAS ≥50% early may optimize the clinical management and improve the outcomes of these high-risk AICVD patients. This study aimed to investigate whether aortic arch plaque (AAP), an early atherosclerotic manifestation of brain blood-supplying arteries, could be a predictor for ACAS ≥50% in AICVD.

Methods:

In this cross-sectional study, atherosclerosis of the coronary and brain blood-supplying arteries was simultaneously evaluated using one-step computed tomography angiography (CTA) in AICVD patients without coronary artery disease history. The patients were divided into ACAS ≥50% and non-ACAS ≥50% groups according to whether CTA showed stenosis ≥50% in at least one coronary arterial segment. The AAP characteristics of CTA were depicted from aspects of thickness, extent, and complexity.

Results:

Among 118 analyzed patients with AICVD, 29/118 (24.6%) patients had ACAS ≥50%, while AAPs were observed in 86/118 (72.9%) patients. Increased AAP thickness per millimeter (adjusted odds ratio [OR]: 1.56, 95% confidence interval [CI]: 1.18–2.05), severe-extent AAP (adjusted OR: 13.66, 95% CI: 2.33–80.15), and presence of complex AAP (adjusted OR: 7.27, 95% CI: 2.30–23.03) were associated with ACAS ≥50% among patients with AICVD, independently of clinical demographics and cervicocephalic atherosclerotic stenosis. The combination of AAP thickness, extent, and complexity predicted ACAS ≥50% with an area under the receiver-operating characteristic curve of 0.78 (95% CI: 0.70–0.85, P < 0.001). All three AAP characteristics provided additional predictive power beyond cervical and intracranial atherosclerotic stenosis for ACAS ≥50% in AICVD (all P < 0.05).

Conclusions:

Thicker, severe-extent, and complex AAP were significant markers of the concomitant ACAS ≥50% in AICVD, possibly superior to the indicative value of cervical and intracranial atherosclerotic stenosis. As an integral part of atherosclerosis of brain blood-supplying arteries, AAP should not be overlooked in predicting ACAS ≥50% for patients with AICVD.

Impact of interactions among metabolic syndrome components on the development of cardiovascular disease among Kazakhs in Xinjiang

Background

Few prospective studies have explored the effect of interactions among metabolic syndrome (MS) components on the development of cardiovascular disease (CVD) in the Kazakh population in Xinjiang Province of China.

Method

As of December 2016, 2,644 participants who completed a baseline survey over a period of 5 years or more were included in the study. The multiplicative interactions among MS components were evaluated by incorporation of the product terms into a logistic regression model. The additive interactions among MS components were evaluated by calculating the additive interaction index. Logistic regression was used to construct a predictive model, and CVD risk level was divided according to the risk probability of the population that did not eventually have CVD.

Results

When we analyzed the independent risk of MS and its components on developing CVD, only blood pressure(BP) and waist circumference(WC) were associated with CVD. A linear association was found between the risk of CVD, BP/WC, and the number of other components (trend, P<0.001). The risk of developing CVD increased when BP and WC coexisted, or when combined BP/WC with MS (≥3 components except for BP and WC) was present; however, there were no significant interactions among MS components. After the CVD hazards were divided into four levels, it was showed that over 19.92% of the incidence probability was in the population under mediate-risk while over 35.24% of them was in the high-risk group, respectively.

Conclusions

BP and WC were independent risk factors for CVD in the Kazakh population. The risk of CVD was greatly increased when BP and WC coexisted or when combined BP/WC with MS (≥3 components except for BP and WC) was present, but no significant interactions were found among MS components.

Detecting Myocardial Ischemia With 99mTechnetium-Tetrofosmin Myocardial Perfusion Imaging in Ischemic Stroke

BACKGROUND

To assess the myocardial status in patients with stroke, employing myocardial perfusion imaging (MPI) with ^99mTechnetium-tetrofosmin (^99mTc-TF)-single-photon emission computed tomography (SPECT).

METHODS

Fifty-two patients with ischemic stroke were subjected to ^99mTc-TF-SPECT MPI within 1 month after stroke occurrence. None of the patients had any history or symptoms of coronary artery disease or other heart disease. Myocardial perfusion imaging was evaluated visually using a 17-segment polar map. Myocardial ischemia (MIS) was defined as present when the summed stress score (SSS) was >4; MIS was defined as mild when SSS was 4 to 8, and moderate/severe with SSS ≥9. Patients with SSS >4 were compared to patients with SSS <4. Parameters such as age, body mass index, waist perimeter, smoking habits, and medical history (diabetes mellitus, dyslipidemia, etc) were evaluated according to MPI results.

RESULTS

Myocardial ischemia was present in 32 (62%) of 52 patients with stroke. Among them, 20 (62%) of 32 patients had mild abnormalities and 12 (38%) of 32 had moderate/severe. The age and waist perimeter showed a tendency to relate to severe MIS when patients with SSS >9 were compared to patients with SSS <4. In MPI-positive patients, an age was to be association with SSS, with the oldest age exhibiting the highest SSS (P = .01). The association of age with SSS remained statistically significant in the multivariate analysis (P = .04).

CONCLUSION

The study suggested that more than half of patients with stroke without a history of cardiac disease have MIS. Although most of them have mild MIS, we suggest a thorough cardiological evaluation in this group of patients for future prevention of severe myocardial outcome.

Coronary Artery Calcium Score Improves the Prediction of Occult Coronary Artery Stenosis in Ischemic Stroke Patients

BACKGROUND

Coronary heart disease is a significant cause of morbidity and mortality in stroke patients. The coronary artery calcium score (CACS) has emerged as a robust and noninvasive predictor of coronary events. We assessed the predictive ability of CACS to identify stroke patients with severe (≥50%) occult coronary artery stenosis in a stroke/transient ischemic attack population, in addition to the PRECORIS score, based on Framingham Risk Score and presence of cervicocephalic artery stenosis, which was derived and validated for that purpose.

METHODS AND RESULTS

We enrolled consecutive patients aged 45 to 75 years referred to our stroke unit with noncardioembolic ischemic stroke or transient ischemic attack, and no prior history of coronary disease. The presence of coronary stenosis was assessed with 64-section computed tomography coronary angiography, and all patients had a detailed etiological work-up. CACS was determined from computed tomography measurement using the Agatson score. The predictive value of CACS was assessed by logistic regression and reclassification method. Among 300 patients included in the study, 274 had computed tomography coronary angiography. Fifty patients (18%) had at least 1 coronary artery stenosis ≥50%. In multivariable analysis, after adjustment for the PRECORIS score, CACS was strongly associated with the presence of occult coronary artery stenosis (odds ratio=14.8 [1.8-120.3] for CACS [1-100] and 70.9 [8.9-562.0] for CACS >100). When CACS was added to the standard model, model fit was improved (P<0.001), Net Reclassification Improvement was 28.2% (P<0.001), and Integrated Discrimination Index was 18.2% (P<0.001).

CONCLUSIONS

In stroke/transient ischemic attack patients, CACS improves the prediction of occult coronary stenosis beyond classical risk factors.

Prognostic Impacts of Metabolic Syndrome in Patients With Chronic Heart Failure - A Multicenter Prospective Cohort Study

BACKGROUND

Metabolic syndrome (MetS) is involved in the increased risk of atherosclerotic cardiovascular diseases. We have previously reported that the prevalence of MetS is more than 2-fold greater in patients with chronic heart failure (CHF) than in the general population in Japan. However, the prognostic impact of MetS in CHF patients remains to be elucidated.

METHODS AND RESULTS

In the present nationwide, large-scale clinical study in Japan, we enrolled 4,762 patients with Stage C/D CHF. The prevalence of MetS by the definition of the Japanese Committee for the Diagnostic Criteria in 2005 was 41.3% (50.6% in males, 21.5% in females). MetS was characterized by higher prevalence of males, obesity and lifestyle-related comorbidities, including glucose intolerance, dyslipidemia and hypertension. Multivariate Cox hazard analysis showed that MetS was associated with increased incidence of the composite of all-cause death and atherosclerotic events in males (hazard ratio [HR] 1.28; 95% confidence interval [CI] 1.06-1.54, P=0.011) but not in females (HR 1.23, 95% CI 0.87-1.75, P=0.241). Among the components of MetS, over waist circumference and glucose intolerance were significantly associated with increased incidence of the composite endpoint (HR 1.23, P=0.038, and HR 1.29, P<0.001, respectively) in males but not in females.

CONCLUSIONS

The results indicate that MetS only has a negative prognostic impact in male CHF patients. (Circ J 2016; 80: 677-688).

Potential Utility of Multidetector Computed Tomography to Identify both Cardiac Embolic Sources and Coronary Artery Disease in Patients with Embolic Stroke

OBJECTIVES

Our objective was to study the potential utility of multidetector computed tomography (MDCT) to identify both cardiac embolic sources and coronary artery disease (CAD) in embolic-stroke patients.

METHODS

We performed MDCT for 184 patients with embolic stroke but without known CAD. Twenty-six patients had atrial fibrillation. We investigated the prevalence of the potential source of the embolism and the coronary characteristics.

RESULTS

Overall, 64 potential embolic sources were detected in 59 patients (32.1%). Left atrial appendage thrombus, left ventricular thrombus and aortic atheroma were detected in 3.3, 0.5 and 15.8% of patients, respectively. Circulatory stasis and patent foramen ovale were detected in 8.7 and 6.5%, respectively. As for coronary calcium score, only 47 patients (25.5%) had a score of zero and 51 (27.7%) had a score of ≥ 400. Significant CAD was detected in 18 patients (9.8%). One hundred and thirty-seven (74.5%) had coronary plaques. The prevalence of positive remodeling, low-attenuation plaque, spotty calcification and a napkin-ring sign was 7.1, 1.6, 5.4 and 2.7%, respectively. Importantly, only 34 patients (13.0%) had no abnormalities detected by MDCT.

CONCLUSIONS

Our results suggest that MDCT has potential to identify both cardiac embolic sources and CAD in patients with embolic stroke but without known CAD.

Comparison of Long-Term Clinical Outcomes after Drug-Eluting Stent Implantation in Patients with Coronary Artery Disease with and without Prior Cerebral Infarction

OBJECTIVE

To compare the clinical and angiographic outcomes after implantation of drug-eluting stents (DESs) in patients with coronary artery disease (CAD) with or without prior cerebral infarction.

MATERIALS AND METHODS

Ninety-eight consecutive patients (130 lesions) who underwent successful coronary DES implantation were prospectively classified into two groups: those with a clinical history of symptomatic cerebral infarction (cerebral infarction group, 49 patients, 69 lesions) and those without a clinical history of symptomatic cerebral infarction (noncerebral infarction group, 49 patients, 61 lesions). The primary endpoint was defined as death, nonfatal myocardial infarction, and cerebrovascular events.

RESULTS

The Kaplan-Meier method was used to create a primary endpoint curves to determine the time-dependent cumulative primary endpoint-free rate, which were compared using the log-rank test. The incidence of primary endpoints was higher in the cerebral infarction group than in the noncerebral infarction group (p = 0.0075). The Cox proportional hazards regression model for primary endpoint identified prior cerebral infarction (p = 0.0331, hazard ratio = 2.827) and patients with peripheral artery disease (p = 0.0271, hazard ratio = 2.757) as explanatory factors.

CONCLUSION

The results showed that clinical outcomes were poorer in patients with CAD who had prior cerebral infarctions than in those who did not have infarction.

Prevalence of subclinical coronary artery disease in ischemic stroke patients

BACKGROUND

Recently, ischemic stroke has emerged as a new coronary artery disease (CAD) risk equivalent. Our purpose is to study the prevalence of CAD in ischemic stroke patients compared with that in non-stroke patients.

METHODS AND RESULTS

We measured coronary calcium score (CCS) in 151 ischemic stroke patients without known CAD (stroke group) and compared it with 151 age- and sex-matched non-stroke patients (control group). CCS was significantly higher in the stroke group than in the control group (stroke group, median: 64, interquartile range: 3-382 vs. control group, median: 3, interquartile range: 0-65, p<0.0001). High-risk CAD, defined as a CCS≥400, was detected in 24.5% of the stroke group compared with 9.3% of the control group (p<0.0001). Agreement between the Framingham risk score and CCS was found in only 62 patients (41.1%). In a multiple logistic regression analysis, age [hazard ratio (HR) 1.09, 95% confidence interval (CI) 1.03-1.14], diabetes (HR 2.97, 95%CI 1.52-5.78), stroke (HR 3.85, 95%CI 1.89-7.81), and male sex (HR 4.41, 95%CI 1.82-0.75) were significantly associated with high-risk CAD (p<0.001).

CONCLUSIONS

Our results show that the prevalence of subclinical CAD in ischemic stroke patients was high, and that a quarter of them had high-risk CAD. Age, diabetes, stroke, and male sex were independent predictors of high-risk CAD.

Predicting Asymptomatic Coronary Artery Diseasein Patients With Ischemic Stroke and Transient Ischemic Attack

Background and Purpose—

Identifying occult coronary artery stenosis may improve secondary prevention of stroke patients. The aim of this study was to derive and validate a simple score to predict severe occult coronary artery stenosis in stroke patients.

Methods—

We derived a score from a French hospital–based cohort of consecutive patients (n=300) who had an ischemic stroke or a transient ischemic attack and no previous history of coronary heart disease (Predicting Asymptomatic Coronary Artery Disease in Patients With Ischemic Stroke and Transient Ischemic Attack [PRECORIS] score) and validated the score in a similar Korean cohort (n=1602). In both cohorts, severe coronary artery stenosis was defined by the presence of at least 1 ≥50% coronary artery stenosis as detected by 64-section CT coronary angiography.

Results—

A 5-point score (Framingham Risk Score–predicted 10-year coronary heart disease risk [≥20%=3; 10–19%=1; <10%=0] and cervicocephalic artery stenosis [≥50%=2; <50%=1; none=0]) was predictive of occult ≥50% coronary artery stenosis risk in the derivation cohort (C-statistic=0.77 [0.70–0.84]) and in the validation cohort (C-statistic=0.66 [0.63–0.68]). The predictive ability of the score was even stronger when only ≥50% left main trunk disease or 3-vessel disease were considered (C-statistic=0.83 [0.74–0.92] and 0.70 [0.66–0.74] in derivation and validation cohorts, respectively). The prevalence of occult ≥50% coronary artery stenosis and ≥50% left main trunk or 3-vessel disease increased gradually with the PRECORIS score, reaching 44.2% and 13.5% in derivation cohort and 49.8% and 12.8% in validation cohort in patients with a PRECORIS score ≥4.

Conclusions—

The PRECORIS score can identify a population of stroke or transient ischemic attack patients with a high prevalence of occult severe coronary artery stenosis.

Asymptomatic polyvascular abnormalities in community (APAC) study in China: objectives, design and baseline characteristics

OBJECTIVE

The population-based "Asymptomatic Polyvascular Abnormalities in Community (APAC) Study was designed to examine prevalence and associations of asymptomatic polyvascular abnormalities (APA) in a general population. In this report, the objectives, design and baseline data of the APAC study are described.

METHODS

The study included 5,440 participants (40.1% women) with an age of 40+ years who were randomly selected from the population of the Kailuan Study which included 101,510 employees and retirees of the Kailuan Co. Ltd, a large coal mine industry located in Tangshan, Hebei, China. Exclusion criteria were previous cerebral stroke, transient ischemic attacks and coronary heart disease. In 2010 and 2011, information on potential cardiovascular risk factors was collected and all participants underwent transcranial Doppler sonography, measurement of the ankle brachial index, and bilateral carotid duplex sonography. In a first follow-up examination in 2012/2013, retinal photography and spectral-domain optical coherence tomography were additionally performed. In a planned long-term follow-up, data from clinical examinations and laboratory tests and the occurrence of cardiovascular or cerebrovascular events will be collected to build up a predicting model for the risk of ischemic events.

RESULTS

At baseline, mean age of the participants was 55.2 ± 11.8 years, and men showed a significantly (P<0.001) higher prevalence of arterial hypertension (55.5% vs. 36.5%) and hyperlipidemia (50.7% vs. 46.0%) and a higher blood homocysteine concentration (18.68 ± 10.28 µmol/L versus 11.69 ± 6.40 µmol/L).

CONCLUSIONS

The APAC is the first study to prospectively evaluate the relationship between intracranial arterial stenosis, retinal nerve fiber layer changes, retinal microvascular signs, and the eventual development of cerebrovascular or cardiovascular events.

Multilevel assessment of atherosclerotic extent using a 40-section multidetector scanner after transient ischemic attack or ischemic stroke

BACKGROUND AND PURPOSE

The first part of this study assessed the potential of MDCT with a CTA examination of the aorta and the coronary, cervical, and intracranial vessels in the etiologic work-up of TIA or ischemic stroke compared with established imaging methods. The objective of the second part of this study was to assess the atherosclerotic extent by use of MDCT in these patients.

MATERIALS AND METHODS

From August 2007 to August 2011, a total of 96 patients with ischemic stroke or TIA without an evident cardioembolic source were enrolled. All patients underwent MDCT. Atherosclerotic extent was classified in 0, 1, 2, 3, and 4 atherosclerotic levels according to the number of arterial territories (aortic arch, coronary, cervical, intracranial) affected by atherosclerosis defined as ≥ 50% cervical, intracranial, or coronary stenosis or ≥ 4-mm aortic arch plaque.

RESULTS

There were 91 patients who had an interpretable MDCT. Mean age was 67.4 years (± 11 years), and 75 patients (83.3%) were men. The prevalence of 0, 1, 2, 3, and 4 atherosclerotic levels was 48.3%, 35.2%, 12.1%, 4.4%, and 0%, respectively. Aortic arch atheroma was found in 47.6% of patients with 1 atherosclerotic level. The combination of aortic arch atheroma and cervical stenosis was found in 63.6% of patients with ≥ 2 atherosclerotic levels. Patients with ≥ 2 atherosclerotic levels were older than patients with < 2 atherosclerotic levels (P = .04) in univariate analysis.

CONCLUSIONS

MDCT might be useful to assess the extent of atherosclerosis. It could help to screen for high-risk patients who could benefit from a more aggressive preventive strategy.

Is there a consistent association between coronary heart disease and ischemic stroke caused by intracranial atherosclerosis?

Coronary heart disease and ischemic stroke are frequent coexistent conditions that share risk factors and pose major burdens to global health. Even though a clear relation has been established between extracranial internal carotid artery atherosclerosis and symptomatic or asymptomatic coronary heart disease, there is a gap in knowledge about the association between intracranial atherosclerosis and coronary heart disease. Intracranial atherosclerosis is associated with high risks of stroke recurrence and vascular death. More research and clinical trials are needed to answer whether early diagnosis of asymptomatic coronary heart disease and aggressive treatment can decrease the risk of vascular death in patients with ischemic stroke caused by intracranial atherosclerosis.

Does motor dysfunction after cerebral infarction impede the development of angina symptoms? A comparison of coronary angiographic findings in patients with and without prior cerebral infarction

Previous studies based on coronary angiography or computed tomography coronary angiography have demonstrated a high prevalence of coronary stenosis in patients with cerebral infarction and no prior history of coronary artery disease (CAD). The purpose of the present study was to compare the coronary angiographic findings of patients with prior cerebral infarction with those of patients with no prior cerebral infarction. Consecutive patients (n = 126) who underwent a first coronary angiography for suspected CAD but had no prior history of CAD were classified into 2 groups, those with a clinical history of cerebral infarction (cerebral infarction group) and those without a clinical history of cerebral infarction (noncerebral infarction group). The incidences of diabetes mellitus, peripheral artery disease, coronary stenosis, and multivessel disease were significantly higher in the cerebral infarction group than in the noncerebral infarction group. Multiple logistic regression analysis relating to coronary stenosis identifi ed prior cerebral infarction (P = 0.0027, odds ratio = 4.414) and diabetes mellitus (P = 0.0446, odds ratio = 2.619) as explanatory factors. Thirty-four of 78 patients (44%) with coronary stenosis did not have angina symptoms. Multiple logistic regression analysis regarding the lack of angina symptoms identified motor dysfunction (modified Rankin scale ≥ 2) (P = 0.0028, odds ratio = 8.323) as an explanatory factor. The results of the present study suggest that compared with patients without cerebral infarction those with the disorder have a high prevalence of coronary stenosis, and indicate that the development of angina symptoms is influenced by the severity of motor dysfunction.

The insulin-like growth factor-1 gene is associated with cerebral infarction in Japanese subjects

Atherosclerosis leads to cerebral infarction (CI) and the insulin/insulin-like growth factor-1 (IGF1) signaling pathway plays an important role in this process during adult life. The purpose of this study was to investigate the relationship between the human IGF1 gene and CI in the Japanese population via a case-control study that also included a separate analysis of the two gender groups. A total of 155 CI patients and 316 controls were genotyped for six single nucleotide polymorphisms (SNPs) of the human IGF1 gene (rs2162679, rs7956547, rs2288378, rs2072592, rs978458 and rs6218). All data were analyzed for three separate groups: the total subjects, men and women. The logistic regression analysis revealed that the GG + AG variant of rs2162679 (P = 0.047), the AA + GA variant of rs2072592 (P = 0.005) and the CC + TC variant of rs6218 (P = 0.015) exhibited a protective effect for CI in the total subject group. For the women and the total subjects groups, the overall distribution of the haplotype established by rs7956547-rs978458 was significantly different between the CI patients and the non-CI subjects. For the total subjects, the frequency of the T-G haplotype (rs7956547-rs978458) was also significantly higher (P = 0.034), whereas the frequency of the T-A haplotype (rs7956547-rs978458) was significantly lower (P = 0.008) in the CI patients versus the non-CI subjects. For women, the frequency of the T-A haplotype (rs7956547-rs978458) was significantly lower (P = 0.021) in the CI patients as compared with the non-CI subjects. The specific SNPs and haplotypes can be utilized as genetic markers for CI resistance or CI risk.

Risk factors associated with ischemic heart disease occurence in acute ischemic stroke patients

AIMS

At specific time periods following ischemic stroke (IS), acute coronary syndrome as ischemic heart disease (IHD) represents a higher risk of death than IS. Not all IS patients can undergo specific examination for IHD detection. The aim of this study was to assess exclusive risk factors (RFs) associated with IHD occurrence in IS patients. Knowledge of these RFs should help in stratifying IS patients for IHD detection.

MATERIALS AND METHODS

This was a hospital-based, retrospective, single centre study. The sample consisted of 192 consecutive IS patients, divided into two subgroups - Subgroup 1 (54 patients without IHD; 55.6% males; 63.1 ± 11.8 years) and Subgroup 2 (138 patients with IHD; 39.1% males; 76.3 ± 9.6 years). The following factors were identified: age; sex; presence of arterial hypertension, atrial fibrillation, diabetes mellitus; plasma levels of total cholesterol, triglycerides, low-density cholesterol, high-density cholesterol; body mass index; presence of carotid plaques. Logistic regression analysis was used for statistical evaluation.

RESULTS

Of all identified risk factors only age (OR=1.109; 95% CI: 1.069 - 1.150, P=0.001) and the presence of arterial hypertension (OR=6.298; 95% CI: 2.215 - 17.905, P=0.003) were exclusively and significantly associated with the presence of IHD in IS patients.

CONCLUSIONS

Age and arterial hypertension may be exclusive risk factors associated with IHD in IS patients.

Pharmacological investigations on potential of peroxisome proliferator-activated receptor-gamma agonists in hyperhomocysteinemia-induced vascular dementia in rats

The present study has been designed to investigate the potential of peroxisome proliferator-activated receptor-gamma ([PPAR]-γ) agonists, pioglitazone, and rosiglitazone in hyperhomocysteinemia-induced vascular dementia of rats. l-methionine was administered for 8 weeks to induce hyperhomocysteinemia and associated vascular dementia. Pioglitazone and rosiglitazone were administered to l-methionine-treated rats for 4 weeks (starting from 5th to 8th weeks of methionine treatment). Donepezil served as a positive control in this study. On 52nd day onward, the animals were exposed to Morris water maze (MWM) for testing learning and memory abilities. Vascular endothelial function, serum nitrite/nitrate levels, brain thiobarbituric acid reactive species (TBARS), brain reduced glutathione (GSH) levels, and brain acetylcholinesterase (AChE) activity were also measured. l-methionine-treated animals have shown impairment of learning, memory, endothelial function, decrease in serum nitrite/nitrate levels, and brain GSH levels along with increase in brain TBARS levels and AChE activity. Pioglitazone, rosiglitazone, and donepezil significantly improved hyperhomocysteinemia-induced impairment of learning, memory, endothelial dysfunction, and changes in various biochemical parameters. It is concluded that pioglitazone and rosiglitazone may be considered as potential pharmacological agents for the management of hyperhomocysteinemia-induced vascular dementia.

Atherothrombosis and the role of antiplatelet therapy

Atherothrombosis remains a major global public health problem. Chronic atherosclerotic disease is often clinically silent and coexists across vascular beds, but when complicated by thrombosis can result in acute coronary syndrome, stroke, transient ischaemic attack and critical limb ischaemia. Platelets play a role in the development of chronic atherosclerotic disease and are a key mediator of clinical events in atherothrombosis. Numerous trials have examined the role of antiplatelet agents in primary and secondary prevention and several new antiplatelet drugs are under development. In secondary prevention, there is evidence of clear benefit of single and in some cases dual antiplatelet therapy in the prevention of recurrent cerebro-vascular complications. Dual antiplatelet therapy has emerged as the standard of care in acute coronary syndromes, with aspirin typically being used in combination with clopidogrel or one of the newer more potent antiplatelet agents. Conversely, in chronic stable coronary disease, no benefit has yet been convincingly demonstrated from dual antiplatelet therapy. In cerebro-vascular disease, aspirin monotherapy remains the cornerstone of prevention of recurrent events, with clopidogrel or the combination of aspirin and dipyridamole being only modestly more efficacious. In primary prevention, the evidence for the routine use of aspirin or any other antiplatelet agent is mixed and suggests this should only be considered on an individual basis in high-risk groups where the thrombotic risk outweighs the risk of major bleeding complications.

The population-based Barcelona-Asymptomatic Intracranial Atherosclerosis Study (ASIA): rationale and design

Background

Large-artery intracranial atherosclerosis may be the most frequent cause of ischemic stroke worldwide. Traditional approaches have attempted to target the disease when it is already symptomatic. However, early detection of intracranial atherosclerosis may allow therapeutic intervention while the disease is still asymptomatic. The prevalence and natural history of asymptomatic intracranial atherosclerosis in Caucasians remain unclear. The aims of the Barcelona-ASymptomatic Intracranial Atherosclerosis (ASIA) study are (1) to determine the prevalence of ASIA in a moderate-high vascular risk population, (2) to study its prognostic impact on the risk of suffering future major ischemic events, and (3) to identify predictors of the development, progression and clinical expression of this condition.

Methods/Design

Cross-over and cohort, population-based study. A randomly selected representative sample of 1,503 subjects with a mild-moderate-high vascular risk (as defined by a REGICOR score ≥ 5%) and with neither a history of cerebrovascular nor ischemic heart disease will be studied. At baseline, all individuals will undergo extracranial and transcranial Color-Coded Duplex (TCCD) ultrasound examinations to detect presence and severity of extra and intracranial atherosclerosis. Intracranial stenoses will be assessed by magnetic resonance angiography (MRA). Clinical and demographic variables will be recorded and blood samples will be drawn to investigate clinical, biological and genetic factors associated with the presence of ASIA. A long-term clinical and sonographic follow-up will be conducted thereafter to identify predictors of disease progression and of incident vascular events.

Discussion

The Barcelona-ASIA is a population-based study aiming to evaluate the prevalence and clinical importance of asymptomatic intracranial large-artery atherosclerosis in Caucasians. The ASIA project may provide a unique scientific resource to better understand the dynamics of intracranial atherosclerosis from its early stages and to identify new potential therapeutic targets for this condition.

Prevalence and clinical implication of metabolic syndrome in chronic heart failure

BACKGROUND

Metabolic syndrome (MetS) is a pathological condition with a clustering of metabolic components and is a well-known risk and prognostic factor for ischemic heart disease (IHD). However, the prevalence and clinical significance of MetS remain to be fully elucidated in chronic heart failure (CHF), an important clinical syndrome caused by various cardiac abnormalities.

METHODS AND RESULTS

The present nationwide, large-scale clinical study enrolled 3,603 patients with stage C/D CHF from 6 institutes in Japan. First, the prevalence of MetS in CHF patients was demonstrated to be 45% in males and 19% in females, which is more than double compared with the general population in Japan. The CHF patients with MetS were characterized by younger age, higher prevalence of current smoking and drinking, IHD, and hypertensive heart disease, whereas the prevalence of HF with preserved ejection fraction and MetS was higher in elderly female patients. Next, the contribution of the metabolic components (waist circumference, hypertension, glucose intolerance/diabetes mellitus and dyslipidemia) was found to be comparable between the ischemic and the non-ischemic CHF patients.

CONCLUSIONS

The prevalence of MetS in CHF patients is more than double compared with the general population in Japan and suggest that the metabolic components may have a substantial effect on the development of both ischemic and non-ischemic CHF.

Addition of losartan to angiotensin-converting enzyme inhibitors improves insulin resistance in patients with chronic heart failure treated without β-blockers

BACKGROUND

Angiotensin II and insulin resistance (IR) have clinical implications in the pathophysiology of chronic heart failure (CHF). However, it is still unclear whether the combination of an angiotensin-receptor blocker and angiotensin-converting enzyme inhibitor (ACEI) improves IR in CHF patients who do not receive β-blockers. Thus, the aim of the present study was to evaluate the effects of losartan on glucose metabolism and inflammatory cytokines in CHF patients treated with ACEI but not β-blockers.

METHODS AND RESULTS

The effect of losartan treatment for 16 weeks on IR was analyzed in 16 CHF patients in a randomized crossover trial. Insulin level and homeostasis model IR index (HOMA-IR) decreased significantly (P<0.05), but fasting plasma glucose did not change significantly. Serum tumor necrosis factor (TNF)-α, interleukin (IL)-6, and monocyte chemoattractant protein (MCP)-1 levels were significantly decreased with losartan (P<0.05). Furthermore, the changes in IL-6 and MCP-1 levels were significantly correlated with the reduction in HOMA-IR (P<0.05), but the change in TNF-α levels was not significantly correlated.

CONCLUSIONS

The addition of losartan to ACEI therapy improved IR and decreased inflammatory cytokines in CHF patients who did not receive β-blockers.

Feasibility and application of single 5F multipurpose catheter in coronary and peripheral angiography via a transradial approach

OBJECTIVE

Atherosclerosis is a systemic disease, in which coronary and peripheral angiographies are required to be done at the same time in a large number of patients. To shorten the procedure time, and reduce complications, we tested the feasibility and the safety of using a single 5F multipurpose catheter, via transradial approach, for coronary, cerebral and renal angiographies.

METHODS

One thousand and ninety-two patients were enrolled in the study. The procedure time, local vessel complications, duration of hospitalization, and costs were evaluated.

RESULTS

Among 1092 patients, the radial artery puncture was successful in 1081 patients, a successful coronary angiography via the radial artery was done in 1074 patients, and the remaining 18 patients had to be accessed via the femoral artery. Thus, successful angiography rate was 97.7% for the right coronary artery, 95.8% for the left coronary artery, 100% for the right cerebral artery, 95.2% for the left subclavian artery, 96.1% for the left carotid artery and 83.1% for the renal artery. The failures were caused by abnormal curvature of the aortic arch and abnormal origins of the above-mentioned arteries. There were 1460 artery stenosis lesions found in 661 patients and 624 lesions (93.3%) needed stents via the transradial approach. The mean procedure time was 20.9 ± 9.3 min including puncture, angiography and hemostasis time. There were 4.35% complications. No local hematoma, hand ischemia, or cerebral infraction was found in this study.

CONCLUSION

Angiography using a single 5F multipurpose catheter, via transradial approach, is associated with a short procedure time and a low rate of complications without affecting the angiography success rate.

Prevalence of asymptomatic coronary artery disease in ischemic stroke patients: the PRECORIS study

BACKGROUND

Coronary artery disease (CAD) is a significant cause of morbidity and mortality in stroke patients. Some patients with asymptomatic CAD might benefit from specific prevention, but the prevalence of asymptomatic CAD is not well known. We assessed the prevalence of >or=50% asymptomatic CAD in patients with ischemic stroke or transient ischemic attack and whether the prevalence is related to traditional vascular risk factors and cervicocephalic atherosclerosis.

METHODS AND RESULTS

From January 2006 to February 2009, consecutive patients between 45 and 75 years of age with nondisabling, noncardioembolic ischemic stroke or transient ischemic attack and no prior history of CAD were enrolled in the study. All patients had a 64-section computed tomography coronary angiography and a detailed cervicocephalic arterial workup. Risk factors were assessed individually and through the Framingham Risk Score. Among 300 patients included in the study, 274 had computed tomography coronary angiography. The prevalence of >or=50% asymptomatic CAD was 18% (95% confidence interval [CI], 14 to 23; n=50). Asymptomatic CAD was independently associated with traditional risk factors assessed individually and through the Framingham Risk Score (odds ratio [OR], 2.6; 95% CI, 1.0 to 7.6 for a 10-year risk of coronary heart disease of 10% to 19%; and OR, 7.3; 95% CI, 2.8 to 19.1 for a 10 year-risk of coronary heart disease >or=20%), the presence of at least 1 >or=50% cervicocephalic artery stenosis (OR, 4.0; 95% CI, 1.4 to 11.2), excessive alcohol consumption (OR, 3.1; 95% CI 1.3 to 7.3), and ankle brachial index <0.9 (OR, 2.2; 95% CI, 0.9 to 5.2). The prevalence of >or=50% asymptomatic CAD was also related to the extent of cervicocephalic atherosclerosis.

CONCLUSIONS

About one fifth of patients with nondisabling, noncardioembolic ischemic stroke or transient ischemic attack have >or=50% asymptomatic CAD. In addition to vascular risk factors, the presence of >or=50% cervicocephalic artery stenosis is strongly related to >or=50% asymptomatic CAD.

Asymptomatic cerebral microbleeds seen in healthy subjects have a strong association with asymptomatic lacunar infarction

BACKGROUND

Cerebral microbleed (CMB), which is conspicuous on gradient-echo T2-weighted magnetic resonance imaging, is a risk factor of intracerebral hemorrhage (ICH). CMBs have been detected even in neurologically healthy persons, who also seem prone to be affected by stroke, not only ICH but also cerebral infarction.

METHODS AND RESULTS

The presence of CMB was investigated in brain dock participants, making reference to silent lacunar infarction (SLI). Participants comprised 377 neurologically healthy persons and 21 (5.6%) had CMB detected, which was associated with a high incidence of hypertension, other conventional risk factors having no significant correlation with CMB. In a simple correlation analysis, CMB showed a positive association with age and systolic blood pressure (SBP). Logistic regression analysis revealed that SLI was the factor most strongly associated with CMB. Moreover, individuals who had both CMB and SLI had higher SBP than other groups.

CONCLUSIONS

The etiology of CMB is similar to that of SLI.

Elderly patients with minimal common carotid atherosclerosis not infrequently have severe coronary atherosclerosis and myocardial infarction

BACKGROUND

The presence of discordances between common carotid and coronary atherosclerosis in the same individual has not been previously reported.

METHODS AND RESULTS

The subjects of the present study were 1,518 consecutive autopsy cases at a general geriatric hospital. All were aged 60 years or older (821 men, 697 women) with an average age of 80 years. The atherosclerotic index of the common carotid artery (CC-AI) and coronary stenotic index (CSI) were semi-quantitatively evaluated. The simple correlation coefficient between the CC-AI and CSI was 0.456 (p<0.0001). Among 689 cases with minimal common carotid atherosclerosis (CC-AI < or =2), 74 (11%) had severe coronary atherosclerosis (CSI > or =12), 68 (10%) had coronary heart disease, and 80 (12%) had pathologically-verified myocardial infarction (MI). Among those with minimal common carotid atherosclerosis, the serum total cholesterol level, diabetes mellitus, and history of smoking were significantly higher or more frequent in cases with a CSI > or =12 than in the patients with a CSI <12.

CONCLUSIONS

A considerable proportion of cases with minimal common carotid atherosclerosis had severe coronary atherosclerosis and MI. This discordance can potentially lead to an underestimation of coronary risks if normal common carotid morphology is obtained by ultrasound.

Clinical utility of evaluating intracranial artery stenosis and silent brain infarction to predict the presence of subclinical coronary artery disease in ischemic stroke patients

OBJECTIVE

We have recently reported the prevalence of subclinical cardiovascular diseases and the association between the presence of subclinical coronary artery disease (CAD) and vascular risk factors in ischemic stroke patients. The relationship between the presence of subclinical CAD and elements of brain ischemia including intracranial artery stenosis, silent brain infarction (SBI), and white matter lesions remains unclear. We determined the usefulness of elements of brain ischemia to predict the presence of subclinical CAD in ischemic stroke patients.

METHODS

The study group comprised 100 patients with first-ever ischemic stroke who had no history of CAD. Intracranial artery stenosis on magnetic resonance angiography and SBI and white matter lesions on magnetic resonance imaging were investigated in comparison with CAD defined as > or =50% stenosis on coronary computed tomographic angiography.

RESULTS

Thirty-six patients had subclinical CAD. Intracranial artery stenosis (78.1% vs 35.1%, p<0.0001) and SBI (69.4% vs 46.9%, p=0.03) were more prevalent in patients with subclinical CAD. Of the patients with both intracranial artery stenosis and SBI, 61% had subclinical CAD. Multiple regression analyses showed that the presence of subclinical CAD was independently associated with intracranial artery stenosis; <50% stenosis (OR 8.01 95%CI 2.02 to 31.9; p<0.01), > or =50% stenosis (OR 19.5 95%CI 2.77 to 137.4; p<0.01), and multiple SBI (OR 3.85 95%CI 1.23 to 12.0; p<0.05).

CONCLUSION

The evaluation of intracranial artery stenosis and SBI may be useful to identify ischemic stroke patients at high risk for subclinical CAD.