Prevalence of Symptomatic Intracranial Atherosclerosis in Caucasians: A Prospective, Multicenter, Transcranial Doppler Study

Tsivgoulis, Georgios; Vadikolias, Κonstantinos; Heliopoulos, Ioannis; Katsibari, Chaido; Voumvourakis, Konstantinos; Tsakaldimi, Soultana; Boutati, Eleni; Vasdekis, Spyros N.; Athanasiadis, Dimitrios; Al‐Attas, Omar S.; Charalampidis, Paris; Stamboulis, Elefterios; Piperidou, Charitomeni

doi:10.1111/j.1552-6569.2012.00707.x

Cited by 44 publications

(47 citation statements)

References 39 publications

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“…Diabetes mellitus (DM), hypertension, and hypercholesterolemia have been found independently associated with ICS in previous studies (3,11,(13)(14)(15)(16)(17)(18)(19)(20)(21). The present study aimed to determine the prevalence, risk factors, and prognosis of ICS in our stroke registry.…”

Section: Introductionmentioning

confidence: 89%

“…Tsivgoulis et al found that DM was the strongest predictive factor of ICS (14). Arenillas et al reported that high lipoprotein (a) level and DM were independent markers of a greater extent for ICS (19).…”

Section: Risk Factors Of Icsmentioning

confidence: 99%

“…There are also several studies showing a significant association between ICS and other vascular risk factors, including hypertension, hyperlipidemia, and metabolic syndrome (3,9,11,13,14,17,18,20,21,25). Advancing age was detected as a significant risk factor for MCA stenosis (13,26).…”

Section: Risk Factors Of Icsmentioning

confidence: 99%

“…ICS is identified in 2.2%-70.4% of patients with ischemic stroke and/or TIA (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Ethnicity appears to be a major risk factor for ICS.…”

Section: Introductionmentioning

confidence: 99%

“…It is common among stroke patients of Asian, Black, and Hispanic ancestry (1)(2)(3)(4)(5)(6)(7)(8)(9)11). Recent European studies have found a much higher prevalence of ICS than commonly presumed (10,(12)(13)(14)(15). However, the prevalence of ICS in patients with acute ischemic stroke has not been reported yet in Turkey.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and prognosis of intracranial stenosis in acute ischemic stroke;a single center registry from Turkey

Sorgun¹,

Yılmaz²,

Ulukan³

et al. 2017

Turk J Med Sci

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The medical records of 619 consecutive patients who were admitted with acute ischemic stroke from January 2012 to November 2014 were retrospectively evaluated. Approval was obtained from the research ethics committee in advance of the study. ICS was defined as any intracranial stenosis >50% on cerebrovascular imaging such as computerized tomography angiography, magnetic resonance angiography, or digital subtraction angiography performed within 1 week of ischemic stroke. The degree of stenosis was calculated according to the WASID method (22). Clot was defined if there was an angiographic evidence of abrupt cut-off or there was vascular imaging evidence that the occluded intracranial artery has been completely recanalized. The patients were divided into two groups: group 1 included patients with ICS and group 2 included patients without ICS.Patient demographics and medical risk factors, including history of hypertension, diabetes, hyperlipidemia, atrial fibrillation, congestive heart failure, coronary artery disease, previous transient ischemic attack, previous Background/aim: Intracranial stenosis (ICS) is identified in 2.2%-70.4% of patients with ischemic stroke and transient ischemic attack. This study aimed to determine the prevalence of ICS in a single center registry from Turkey. Materials and methods:We reviewed the charts of 619 patients with acute ischemic stroke. ICS was defined as any ICS > 50% on cerebrovascular imaging. The demographic data, risk factors, NIHSS scores and C reactive protein level at admission, mortality in hospital, recurrent stroke, and mRS in the follow-up period were recorded.Results: A total of 72 (11.6%) patients with ICS (45 males (62.5%); mean age 68.3 ± 12.6 years) were included. Sixty-seven patients (10.8%) had symptomatic ICS and 44 patients (7.1%) had ICS without extracranial stenosis. Diabetes mellitus (DM) was significantly higher in the ICS group compared to the others (P = 0.017). Disability was significantly better in patients with ICS compared to the others (P < 0.001). On logistic regression analysis, DM and follow up mRS were significantly associated with ICS (P < 0.05). Conclusion:ICS was seen in 11.6% of acute ischemic stroke cases in our registry. DM appears to be the major risk factor for ICS. Disability was better in patients with ICS. Ethnicity could be a factor causing better disability.

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Section: Introductionmentioning

confidence: 89%

Section: Risk Factors Of Icsmentioning

confidence: 99%

Section: Risk Factors Of Icsmentioning

confidence: 99%

“…ICS is identified in 2.2%-70.4% of patients with ischemic stroke and/or TIA (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Ethnicity appears to be a major risk factor for ICS.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence and prognosis of intracranial stenosis in acute ischemic stroke;a single center registry from Turkey

Sorgun¹,

Yılmaz²,

Ulukan³

et al. 2017

Turk J Med Sci

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Prognosis of Asymptomatic Intracranial Stenosis in Patients With Transient Ischemic Attack and Minor Stroke

Hurford

Wolters

et al. 2020

JAMA Neurol

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IMPORTANCE Asymptomatic intracranial stenosis (ICS) is a frequent finding on imaging results, particularly in the assessment of acute stroke. Although the management of symptomatic ICS is informed by randomized trials, to our knowledge there are few data on the prevalence and prognosis of asymptomatic ICS in patients with stroke and transient ischemic attack (TIA). OBJECTIVE To study the age-specific prevalence and prognosis of asymptomatic ICS in a population-based cohort of patients with TIA and minor stroke. DESIGN, SETTING, AND PARTICIPANTS All patients (predominantly white) recruited to the Oxford Vascular Study (Oxfordshire, England) between March 1, 2011, and March 1, 2018, with TIA and minor ischemic stroke (National Institutes of Health Stroke Scale score, Յ3), irrespective of age, were included (n = 1579). We determined the age-specific prevalence of 50% or more asymptomatic ICS and the associated stroke risk by face-to-face follow-up to 2018 on standard medical treatment without stenting. EXPOSURES Patients underwent magnetic resonance angiography of the intracranial and cervicocranial arteries, computed tomography angiography if magnetic resonance angiography was contraindicated, or carotid/transcranial Doppler ultrasonography if computed tomography angiography was contraindicated. MAIN OUTCOMES AND MEASURES The primary outcomes were the prevalence and prognosis of asymptomatic ICS. RESULTS Of 1368 eligible patients (mean [SD] age, 69.2 [13.9] years; 700 men [51.2%]) with intracranial vascular imaging, 426 ICS were identified in 260 patients (19.0%): 58 (4.2%) with only symptomatic ICS, 155 (11.3%) with only asymptomatic ICS, and 47 (3.4%) with both. The prevalence of any asymptomatic ICS increased from 4.8% for patients younger than 70 years to 34.6% for patients 90 years or older (P for trend < .001; odds ratio per decade, 1.96; 95% CI, 1.69-2.27) and was greater than that of 50% or more asymptomatic carotid bifurcation stenosis (202 [14.8%] vs 105 patients [7.2%]; relative risk, 2.04; 95% CI, 1.63-2.55, P < .001). However, the 155 patients with only asymptomatic ICS had no increase in risk of ischemic stroke compared with those with no ICS (unadjusted HR, 1.03, 95% CI, 0.49-2.17), with 8 first recurrent events (5.2%) during 506 patient-years of follow-up and 3 in the territory of the ICS (annualized risk, 0.59%; 95% CI, 0.12-1.73). CONCLUSIONS AND RELEVANCE The prevalence of asymptomatic ICS increases with age in white patients with TIA and minor stroke and is greater than that of asymptomatic carotid stenosis, but asymptomatic ICS does not increase the short-or medium-term risk of distal recurrent ischemic stroke for patients receiving standard medical treatment.

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Transcranial color Doppler sonography as an alternative tool for evaluation of terminal internal carotid artery steno‐occlusion in moyamoya disease

Wang

Zhang

Wei

et al. 2021

J of Clinical Ultrasound

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Objective: To investigate color Doppler ultrasonography criteria and its value in assessing the steno-occlusion of the terminal internal carotid artery in moyamoya disease.Methods: According to the digital subtraction angiography findings, patients were divided into three groups: occlusion of the terminal internal carotid artery, >50% stenosis, and ≤50% stenosis. We measured the terminal and proximal internal carotid artery parameters of each group using transcranial and cervical color Doppler sonography.Results: Blood flow signals in 12 terminal internal carotid arteries were absent, which were verified as occlusion by digital subtraction angiography. Parameters were obtained in the remaining 159 terminal/proximal internal carotid arteries to predict cutoffs for >50% stenosis and occlusion. For >50% stenosis, mean flow velocity >88.50 cm/s in the terminal internal carotid artery could achieved the highest receiver operating characteristic curve area of 0.776 with 62.50% sensitivity, 88.15% specificity, 48.39% positive predictive values, 92.97% negative predictive value, and 84.27% overall accuracy. For the occlusion, mean flow velocity <49.50 cm/s in the terminal internal carotid artery achieve the highest receiver operating characteristic curve area of 0.734 with 55.56% sensitivity, 83.81% specificity, 63.83% positive predictive values, 78.57% negative predictive value, and 74.21% overall accuracy. The area under receiver operating characteristic curve cutoffs for other parameters were less than 0.7. Conclusion:Mean flow velocity of terminal internal carotid artery provides useful diagnostic information for detecting steno-occlusion in moyamoya disease. It may be used as an alternative tool to evaluate steno-occlusion of the terminal internal carotid artery in moyamoya disease.

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Prevalence of Symptomatic Intracranial Atherosclerosis in Caucasians: A Prospective, Multicenter, Transcranial Doppler Study

Abstract: SIA was identified in almost 10% of patients admitted with symptoms of ACI. These preliminary findings support further collaborative initiatives among stroke physicians to increase the yield of SIA detection in Caucasian patients with ACI.

Cited by 44 publications

References 39 publications

Prevalence and prognosis of intracranial stenosis in acute ischemic stroke;a single center registry from Turkey

Prevalence and prognosis of intracranial stenosis in acute ischemic stroke;a single center registry from Turkey

Prognosis of Asymptomatic Intracranial Stenosis in Patients With Transient Ischemic Attack and Minor Stroke

Transcranial color Doppler sonography as an alternative tool for evaluation of terminal internal carotid artery steno‐occlusion in moyamoya disease

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