Intracranial Vertebrobasilar Calcification in Patients with Ischemic Stroke Is a Predictor of Recurrent Stroke, Vascular Disease, and Death: A Case-Control Study

Abstract

Intracranial artery calcification can be detected on nonenhanced brain computer tomography (NECT) and is a predictor of early vascular events. Here, we assessed the impact of vertebrobasilar artery calcification (VBC) on the long-term risk for recurrent stroke and vascular events. We performed a case-control trial of all consecutive stroke patients admitted to the University Hospital of Maribor, Slovenia over a period of 14 months. VBC was defined as presence of a hyperdense area within vertebrobasilar arteries that exceeds > 90 Hounsfield units as seen on NECT. Clinical follow-up information was obtained from the hospital documentation system and mortality registry of the district and included recurrent stroke, subsequent vascular events (myocardial infarction, heart failure, peripheral arterial occlusive disease), and death. We followed a total of 448 patients for a median of 1505 days (interquartile range, IQR 188-2479). Evidence for VBC was present in 243 (54.2%) patients. Median age was 76 years, recurrent stroke occurred in 33 (7.4%), any vascular events in 71 (15.8%), and death in 276 (61.6%). VBC was associated with a higher risk of recurrent stroke (hazard ratio, HR 3.13, 95% confidence interval ) and vascular events (HR 2.05, 95% CI 1.21-3.47). Advanced age, male gender, and ischemic stroke involving the entire anterior circulation raised the likelihood for death. We conclude that the presence of VBC in patients with ischemic stroke is a shortand long-term prognostic factor for stroke recurrence and subsequent manifestation of acute vascular disease. Further understanding of the pathophysiology of VBC is warranted.

Carotid Siphon Calcification Predicts the Symptomatic Progression in Branch Artery Disease With Intracranial Artery Stenosis—Brief Report

“… 6 Vertebrobasilar calcification in patients with ischemic stroke is a valid predictor for stroke recurrence and acute vascular disease. 7 Coronary artery calcification in patients with atrial fibrillation has increased the independent risk of stroke, 3 but carotid calcification is not associated with incident stroke. 8 …”

Admission Serum Calcium Level and Short-Term Mortality After Acute Ischemic Stroke: A Secondary Analysis Based on a Norwegian Retrospective Cohort

“…Previous studies revealed the key role of serum calcium in the promotion of vascular calcification, which is a complex process including the promotion of osteogenic/chondrogenic differentiation, vesicle release, cell apoptosis, loss of inhibitors, and extracellular matrix degradation ( 31 , 32 ), leading to atherosclerosis. Thus, elevated serum calcium levels may accelerate the process of atherosclerosis, cardio-cerebrovascular calcification, and plaque rupture which has been associated with poor clinical outcomes ( 33 – 35 ). In addition, calcium ion is a crucial intracellular messenger, and plays a key role in neuronal damage and cell death ( 26 ).…”

Arterial Calcification and Its Association With Stroke: Implication of Risk, Prognosis, Treatment Response, and Prevention

“…In patients with TIA, a higher calcium volume was associated with a higher risk of recurrent TIA or AIS ( Kong et al, 2019 ). In addition, two studies found that in patients with AIS, the presence of VBA calcification is also associated with long-term risk of recurrent stroke ( Gökçal et al, 2018 )and mortality ( Magdič et al, 2020 ). As for stroke subtypes, IAC was associated with a higher risk of recurrence only in patients with index small-vessel occlusive stroke ( Wu et al, 2020 ), suggesting that IAC might serve as a valuable predictor of recurrence in this subtype of stroke.…”