Presence of Intracranial Artery Calcification Is Associated With Mortality and Vascular Events in Patients With Ischemic Stroke After Hospital Discharge

Bugnicourt, Jean‐Marc; Leclercq, Claire; Chillon, Jean‐Marc; Diouf, Momar; Deramond, H.; Canaple, Sandrine; Lamy, Chantal; Massy, Ziad A.; Godefroy, Olivier

doi:10.1161/strokeaha.111.618652

Cited by 65 publications

(59 citation statements)

References 36 publications

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“…The mechanism for which TCSC increases mortality is independent and seemingly uncorrelated with stroke severity and hemodynamic outcomes. Also, this association is not probably directly related with thrombolysis in itself, as it has been described in other stroke patients not submitted to thrombolysis [17]. Going back up to the first paragraph of this article, vessel calcification, despite its location, is a marker of systemic atherosclerosis, which could explain the lower life expectancy of these patients.…”

Section: Discussionmentioning

confidence: 69%

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

et al. 2017

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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.

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Section: Discussionmentioning

confidence: 69%

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

et al. 2017

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“…12 Because intracranial atherosclerosis may represent an important and potentially modifiable risk factor for recurrent ischaemic events in an European stroke population, we aimed at (1) establishing the incidence of IAS and calcifications in an acute northern European thrombolysis population identified during acute radiological examination; (2) identifying potential modifiable risk-factors; and (3) assessing whether intracranial atherosclerosis identified during acute stroke evaluation predicts poor long-term outcome.…”

Section: Article Summarymentioning

confidence: 99%

“…12 Data extraction and definitions Data were prospectively collected from all patients on a daily basis from charts and by direct interview. All previous concurrent medical conditions (stroke/TIA, ischaemic heart disease (IHD), congestive heart failure and periphery artery disease) were confirmed by registrations in previous medical charts.…”

Section: Radiological Imagingmentioning

confidence: 99%

Prevalence and long-term clinical significance of intracranial atherosclerosis after ischaemic stroke or transient ischaemic attack: a cohort study

et al. 2013

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ObjectivesWe investigated the prevalence and long-term risk associated with intracranial atherosclerosis identified during routine evaluation.DesignThis study presents data from a prospective cohort of patients admitted to our stroke unit for thrombolysis evaluation.Setting and participantsWe included 652 with a final diagnosis of ischaemic stroke or transient ischaemic attack (TIA) from April 2009 to December 2011. All patients were acutely evaluated with cerebral CT and CT angiography (CTA). Acute radiological examinations were screened for intracranial arterial stenosis (IAS) or intracranial arterial calcifications (IAC). Intracranial stenosis was grouped into 30–50%, 50–70% and >70% lumen reduction. The extent of IAC was graded as number of vessels affected.Primary and secondary outcome measurePatients were followed until July 2013. Recurrence of an ischaemic event (stroke, ischaemic heart disease (IHD) and TIA) was documented through the national chart system. Poor outcome was defined as death or recurrence of ischaemic event.Results101 (15.5%) patients showed IAS (70: 30–50%, 29: 50–70% and 16: >70%). Two-hundred and fifteen (33%) patients had no IAC, 339 (52%) in 1–2 vessels and 102 (16%) in >2 vessels. During follow-up, 53 strokes, 20 TIA and 14 IHD occurred, and 95 patients died. The risk of poor outcome was significantly different among different extents of IAS as well as IAC (log-rank test p<0.01 for both). In unadjusted analysis IAS and IAC predicted poor outcome and recurrent ischaemic event. When adjusted, IAS and IAC independently increased the risk of a recurrent ischaemic event (IAS: HR 1.67; CI 1.04 to 2.64 and IAC: HR 1.22; CI 1.02 to 1.47).ConclusionsIntracranial atherosclerosis detected during acute evaluation predicts an increased risk of recurrent stroke.

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“…Calcifications in both intracranial and extracranial arteries are associated with non-cardioembolic ischemic strokes 22 . Among stroke patients, intracranial arterial calcifications have been shown to be associated with future recurrent strokes and mortality 23 . In our study, presence of any calcifications in the brain large arteries was associated with CAD and ischemic infarcts.…”

Section: Discussionmentioning

confidence: 99%

Pathological correlates of brain arterial calcifications

Shapiro

Goldman

Morgello

et al. 2019

Cardiovascular Pathology

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Background: In clinical practice, calcifications seen on CT studies within the large brain arteries are often referred as a surrogate marker for cholesterol-mediated atherosclerosis. However, limited data exists to support the association between calcification and atherosclerosis. In this study, we examined if intracranial arterial calcifications were associated with cholesterol-mediated intracranial large artery atherosclerosis (ILAA) within the arteries of the Circle of Willis in an autopsy based sample. Methods: We carried out a cross-sectional analysis of histopathological characteristics of brain large arteries obtained from autopsy cases. Brain large arteries were examined for evidences of calcifications, which were rated as macroscopic (coalescent) and microscopic (scattered). In addition to calcification, we also obtained measurement of the arterial wall and the presence of ILAA and non-atherosclerotic arterial fibrosis. We built hierarchical models adjusted for demographic and vascular risk factors to assess the relationship between calcification and ILAA. Results: In univariate analysis, the presence of any arterial calcifications was associated with cerebral infarcts (29% v. 14%, p<0.01). Multi-variate analysis revealed that among all calcifications, coalescent calcifications were not associated with ILAA. In contrast, scattered calcifications were associated with ILAA (p<0.001), decreased lumen diameter (−1.87 +/− 0.41 mm p≤0.001) and increased luminal stenosis (0.03 +/− 0.01% p≤0.006). These findings were independent of age, sex or other vascular risk factors. Conclusions: This study demonstrates that coalescent calcifications in brain large arteries, although associated with morbidity, are not synonymous with cholesterol driven ILAA. Understanding the precise pathological components of cerebrovascular disease, including non-atherosclerotic arterial calcifications, will help develop individualized therapies beyond amelioration of traditional risk factors such as hyperlipidemia.

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Presence of Intracranial Artery Calcification Is Associated With Mortality and Vascular Events in Patients With Ischemic Stroke After Hospital Discharge

Cited by 65 publications

References 36 publications

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

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

Prevalence and long-term clinical significance of intracranial atherosclerosis after ischaemic stroke or transient ischaemic attack: a cohort study

Pathological correlates of brain arterial calcifications

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