Cryptogenic Stroke and Nonstenosing Intracranial Calcified Atherosclerosis.

TitleCryptogenic Stroke and Nonstenosing Intracranial Calcified Atherosclerosis.
Publication TypeJournal Article
Year of Publication2017
AuthorsKamel H, Gialdini G, Baradaran H, Giambrone AE, Navi BB, Lerario MP, Min JK, Iadecola C, Gupta A
JournalJ Stroke Cerebrovasc Dis
Date Published2017 Apr
KeywordsAged, Aged, 80 and over, Calcinosis, Calcium, Carotid Artery, Internal, Cerebral Infarction, Female, Humans, Intracranial Arteriosclerosis, Male, Middle Aged, Prospective Studies, Retrospective Studies, Risk Factors, Severity of Illness Index, Statistics, Nonparametric, Stroke, Tomography, X-Ray Computed

OBJECTIVE: Because some cryptogenic strokes may result from large-artery atherosclerosis that goes unrecognized as it causes <50% luminal stenosis, we compared the prevalence of nonstenosing intracranial atherosclerotic plaques ipsilateral to cryptogenic cerebral infarcts versus the unaffected side using imaging biomarkers of calcium burden.

METHODS: In a prospective stroke registry, we identified patients with cerebral infarction limited to the territory of one internal carotid artery (ICA). We included patients with stroke of undetermined etiology and, as controls, patients with cardioembolic stroke. We used noncontrast computed tomography to measure calcification in both intracranial ICAs, including qualitative calcium scoring and quantitative scoring utilizing the Agatston-Janowitz (AJ) calcium scoring. Within subjects, the Wilcoxon signed-rank sum test for nonparametric paired data was used to compare the calcium burden in the ICA upstream of the infarction versus the ICA on the unaffected side.

RESULTS: We obtained 440 calcium measures from 110 ICAs in 55 patients. Among 34 patients with stroke of undetermined etiology, we found greater calcium in the ICA ipsilateral to the infarction (mean Modified Woodcock Visual Scale score, 6.7 ± 4.6) compared with the contralateral side (5.4 ± 4.1) (P = .005). Among 21 patients with cardioembolic stroke, we found no difference in calcium burden ipsilateral to the infarction (6.7 ± 5.9) versus the contralateral side (7.3 ± 6.3) (P = .13). The results were similar using quantitative calcium measurements, including the AJ calcium scores.

CONCLUSION: In patients with strokes of undetermined etiology, the burden of calcified intracranial large-artery plaque was associated with downstream cerebral infarction.

Alternate JournalJ Stroke Cerebrovasc Dis
PubMed ID27887791
PubMed Central IDPMC5362370
Grant ListK23 NS082367 / NS / NINDS NIH HHS / United States
K23 NS091395 / NS / NINDS NIH HHS / United States
KL2 TR000458 / TR / NCATS NIH HHS / United States
R01 NS034179 / NS / NINDS NIH HHS / United States