Intracranial Internal Carotid Artery Wall Calcification in Ischemic Strokes Treated with Thrombolysis

Abstract

Background: Calcifications are an important element of atherosclerotic plaques and have been used as a marker of atherosclerosis and clinical outcome predictor in different vascular territories. CT-scan, performed in the acute ischemic stroke setting, can reliably detect intracranial arterial calcifications. Objectives: To investigate the association between intracranial internal carotid artery calcification and functional outcome, symptomatic intracerebral hemorrhage (sICH), recanalization, and death. Methods: We included 396 consecutive ischemic stroke patients submitted to recombinant tissue plasminogen activator treatment between January 2011 and September 2014. Admission CT-scans were reviewed to calculate the Total Carotid Syphon Calcification score. Patients were followed for up to at least 6 months post-stroke or until death. Outcome measures included evaluation of recanalization on the first 24 h (transcranial color coded Doppler or angio-CT), sICH, and assessment of functional outcome at 3 months after stroke (using modified Rankin scale). Results: Carotid artery wall calcification did not predict sICH, recanalization or any good outcome. However, it was a statistically significant predictor of death (OR 1.102, 95% CI [1.004–1.211], p = 0.042). Discussion: Intracranial carotid artery calcification does not increase the risk of thrombolysis-induced sICH. Patients with higher grade of carotid artery wall calcification may have a higher mortality rate.

Lack of Correlation Between Intracranial Carotid Artery Modified Woodcock Calcification Score and Prognosis of Patients With Acute Ischemic Stroke After Intravenous Thrombolysis

“…There are many discrepancies among other studies and ours, such as different ICAC assessment methods; e.g., both of the studies used the Total Carotid Siphon Calcification (TCSC) score (33, 34) but different inclusion and exclusion criteria. For example, Tábuas-Pereira et al (34) included patients with posterior circulation infarctions. In addition, different grouping methods were used; e.g., Lin et al (33) dichotomized patients into two groups according to TCSC scores rather than analyzing the scores as continuous variables.…”

“…Lin et al (33) showed that AIS patients with moderate to severe ICAC were more at risk of ICH but not sICH than patients with no or minor ICAC. In addition, Tábuas-Pereira et al (34) found that AIS patients with higher grades of ICAC have higher mortality rates following IVT. There are many discrepancies among other studies and ours, such as different ICAC assessment methods; e.g., both of the studies used the Total Carotid Siphon Calcification (TCSC) score (33, 34) but different inclusion and exclusion criteria.…”

“…In addition, Tábuas-Pereira et al (34) found that AIS patients with higher grades of ICAC have higher mortality rates following IVT. There are many discrepancies among other studies and ours, such as different ICAC assessment methods; e.g., both of the studies used the Total Carotid Siphon Calcification (TCSC) score (33, 34) but different inclusion and exclusion criteria. For example, Tábuas-Pereira et al (34) included patients with posterior circulation infarctions.…”

Do We Need to Distinguish Thrombolysis and Nonthrombolysis Patients When Applying Stroke-Associated Pneumonia Predicting Scores? An External Validation from a 2-Center Database

“…Furthermore, according to the previous epidemiological investigation, 58.1% of thrombolysis-treated patients with IS get satisfactory vascular recanalization and 5.8% patients have symptomatic intracranial hemorrhage [ 24 ]. In other words, neurological function improvement does not occur in approximately half of patients.…”

Current knowledge of large vascular occlusion due to intracranial atherosclerosis: focusing on early diagnosis

“…A plain CT scan can present the infarcted territory and provide some clues of the etiology of AIS. High-density plaques in the CT scans can be observed in patients with symptomatic ICAS, which may also be observed in patient ICAS-LVO related AIS [ 33 , 34 ]. This sign usually indicates the calcification of atherosclerotic plaque.…”