Intracranial atherosclerosis is the most common stroke subtype: Ten-year data from hyderabad stroke registry (India)

Kaul, Subhash; Alladi, Suvarna; Jabeen, Shaik Afshan; Bandaru, V C S Srinivasarao; Ankem, Usharani; Mekala, Shailaja; Naik, Gireesha

doi:10.4103/aian.aian_86_18

Cited by 23 publications

(26 citation statements)

References 26 publications

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“…Embolic strokes due to emboli originating from the heart or extracranial large arteries are common in Western populations, whereas small-vessel occlusion or intracranial atherosclerosis is more prevalent in Asians [ 23 ]. Whites have more extracranial carotid atherosclerosis [ 20 , 24 ], whereas Asians have more intracranial atherosclerotic disease [ 22 , 25 , 26 ]; 54% of ethnic South Asians living in Singapore [ 27 ] and 29.4% of Indian patients in the Hyderabad stroke registry [ 28 ] were reported to have intracranial large-artery disease. Among ischaemic stroke subtypes, lacunar strokes, which were once the commonest variety in Asians, are now declining.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and correlates of carotid artery stenosis in a cohort of Sri Lankan ischaemic stroke patients

et al. 2021

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Background Large artery atherosclerotic disease is an important cause of stroke, accounting for 15–46% of ischaemic strokes in population-based studies. Therefore, current guidelines from west recommend urgent carotid imaging in all ischaemic strokes or transient ischaemic attacks and referral for carotid endarterectomy. However, the clinical features and epidemiology of stroke in Asians are different from those in Caucasians and therefore the applicability of these recommendations to Asians is controversial. Data on the prevalence of carotid artery stenosis (CAS) among South Asian stroke patients is limited. Therefore, we sought to determine the prevalence and associated factors of significant CAS in a cohort of Sri Lankan patients with ischaemic stroke. Methods We prospectively studied all ischaemic stroke patients who underwent carotid doppler ultrasonography admitted to the stroke unit of a Sri Lankan tertiary care hospital over 5 years. We defined carotid stenosis as low (< 50%), moderate (50–69%) or severe (70–99%) or total-occlusion (100%) by North American Symptomatic Trial Collaborators (NASCET) criteria. We identified the factors associated with CAS ≥ 50% and ≥ 70% by stepwise multiple logistic regression analysis. Results A total of 550 ischaemic stroke patients (326 (59.3%) male, mean age was 58.9 ± 10.2 years) had carotid doppler ultrasonography. Of them, 528 (96.0%) had low-grade, 12 (2.2%) moderate and 7 (1.3%) severe stenosis and 3 (0.5%) had total occlusion. On multivariate logistic regression, age was associated with CAS ≥ 50% (OR 1.12, p = 0.001) and CAS ≥ 70% (OR 1.14, p = 0.016), but none of the other vascular risk factors studied (sex, hypertension, diabetes mellitus, smoking, past history of TIA, stroke or ischemic heart disease) showed significant associations. Conclusions Carotid stenosis is a minor cause of ischemic stroke in Sri Lankans compared to western populations with only 4.0% having CAS ≥ 50 and 3.5% eligible for carotid endarterectomy. Our findings have implications for the management of acute strokes in Sri Lanka.

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Section: Discussionmentioning

confidence: 99%

Prevalence and correlates of carotid artery stenosis in a cohort of Sri Lankan ischaemic stroke patients

et al. 2021

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“…The authors noted association of ICAD with hyperlipidemia in LAA and those cardioembolic strokes. (19) From our data those with large artery strokes had higher and those with lacunar infarcts had lower occurrence of ICAD.…”

Section: Discussionmentioning

confidence: 46%

“…Although the association of hyperlipidemia with ICAD has been demonstrated from past studies (8,19,20), the APAC study concluded that triglycerides (TG) are a signi cant factor only for progression of atherosclerosis, (21) another study concluded TG: HDL cholesterol ratio to be signi cantly associated with ICAD in healthy subjects. (22) We noted that ICAD was signi cantly associated in those with previous history of hyperlipidemia.…”

Section: Discussionmentioning

confidence: 99%

Intracranial Atherosclerosis in Stroke Patients, Which Risk Factors Are Important? A Study From Mixed Ethnic Population in Singapore.

Pande

Lwin

Khine

et al. 2021

Preprint

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Intracranial atherosclerosis (ICAD) although more common in Asians, has not been studied from Singapore population. The aim of this study is to identify prevalence ICAD in stroke subjects, its association with comorbidities, stroke subtypes and long-term survival. We performed retrospective analysis of 681 stroke patients, 327(48%) had ICAD) with 232 (71%) having one or more intracranial artery with significant stenosis. ICAD was associated with older age, ischaemic strokes, total anterior circulation syndrome (TACS), large artery strokes (p<0.001), peripheral vascular disease (PVD, p=0.018), diabetes mellitus (DM), and with history of hyperlipidemia. In addition, higher serum potassium (p=0.046) and glucose (p<0.001), lower haemoglobin (p=0.040) and aortic valve sclerosis were significantly associated with ICAD (p<0.001). Multivariable analysis showed a significant independent association of ICAD with advancing age, history of hyperlipidemia and DM.In ischemic strokes (489), 311(64%) had ICAD of which 229(72%) had significant stenosis. Of the 192 hemorrhagic strokes, 16 (8%) had ICAD.Conclusion: The prevalence of ICAD, especially in ischemic strokes, from our study is high. As modifiable risk factors such as hyperlipidemia and DM appear to be associated with ICAD, then proactive management of these conditions may improve long term associated complications. Prospective studies may help to validate our findings.

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“…In a study conducted by Intizari 7 on 1,158 patients with hemispheric stroke, 493 (42.5%) had features of lacunar stroke which is similar to our study. An analysis done on 893 patients of ischemic stroke in the stroke registry of Nizam's Institute of Medical Sciences, Hyderabad, 8 showed 16% of stroke patients with lacunar infarction. In contrast to our results, a study conducted on stroke in south Alabama, 9 lacunar infarct composed of 13% of stroke patients.…”

Section: Discussionmentioning

confidence: 99%

To Study the Incidence of Lacunar Infarcts in Patients with Acute Ischemic Stroke and its Correlation with Carotid Artery Stenosis

Mohan¹,

Singh²

2018

AMEI's Current Trends in Diagnosis &Amp; Treatment

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Introduction: Stroke remains the second leading cause of death worldwide, after ischemic heart disease. Lacunar infarcts are small deep infarcts ranging from 2 to 20 mm in size resulting from occlusion of a penetrating artery which accounts for approximately 25% of all ischemic strokes. The present study was undertaken to study the incidence of lacunar infarcts in patients with acute ischemic stroke and its correlation with carotid stenosis. Materials and methods:This study was performed at the Department of Medicine at a tertiary-care hospital in Amritsar, Punjab, in 50 patients presenting with acute ischemic stroke with or without lacunar syndrome. All patients were diagnosed using diffusion-weighted imaging (DWI) on magnetic resonance imaging (MRI) of the brain. Carotid artery stenosis was measured with duplex ultrasound. Results:Patients with acute ischemic stroke had a mean age of 61.36 ± 11.36 years. About 40% of the patients had lacunar infarcts with a higher frequency in male patients (64% vs 36%). There was no significant difference found in the incidence of hypertension (85% vs 70%), diabetes (20% vs 13.3%, p value = 0.529), alcohol drinking (20% vs 16.67.0%, p value = 0.764), smoking (23% vs 10% p value = 0.318), and carotid artery stenosis (35% vs 43.3%, p value = 0.828) between lacunar and non-lacunar infarct patients. Conclusion:The difference in the incidence of potential risk factors such as hypertension, diabetes mellitus, alcoholism, smoking, and dyslipidemia was found to be statistically insignificant between lacunar and non-lacunar infarct groups. Carotid stenosis did not show any significant difference in the lacunar and non-lacunar infarct groups. The findings in our study are consistent with the hypothesis that severe carotid artery stenosis in lacunar infarction is an incidental finding.

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Intracranial atherosclerosis is the most common stroke subtype: Ten-year data from hyderabad stroke registry (India)

Cited by 23 publications

References 26 publications

Prevalence and correlates of carotid artery stenosis in a cohort of Sri Lankan ischaemic stroke patients

Prevalence and correlates of carotid artery stenosis in a cohort of Sri Lankan ischaemic stroke patients

Intracranial Atherosclerosis in Stroke Patients, Which Risk Factors Are Important? A Study From Mixed Ethnic Population in Singapore.

To Study the Incidence of Lacunar Infarcts in Patients with Acute Ischemic Stroke and its Correlation with Carotid Artery Stenosis

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