Prevalence and Risk Factors Comparison of Anterior and Posterior Intracranial Arterial Stenosis

The prevalence and risk factors of intracranial atherosclerotic stenosis (ICAS) located in the anterior circulation (AC) and posterior circulation (PC) has been scarcely noted in the general population. We aimed to determine ICAS prevalence and risk factor profile of AC and PC in a representative population. Data were from the China Hypertension Survey of Beijing. In total, 4800 people aged 35 years or older were enrolled in this subsurvey for ICAS, and 3954 participants were eligible for analysis. ICAS was assessed by transcranial Doppler. The prevalence of ICAS in AC was much greater than that in PC (11.9% vs. 4.2%), and subjects with ICAS in PC were 3.9 years older than those with ICAS in AC. Multivariable logistics regression showed that the odds of hypertension and diabetes increased by 79% (OR: 1.79, 95% CI: 1.40–2.27) and 35% (OR: 1.35, 95% CI: 1.04–1.75) in those with AC vascular lesions and by 3.35 times (OR: 3.35, 95% CI: 2.49–4.50) and 71% (OR: 1.71, 95% CI: 1.19–2.46) in those with PC vascular lesions compared with those without vascular lesions. Most modifiable vascular risk factors for ICAS appeared to exert similar magnitudes of risk for PC to AC lesions.

Fluid-Attenuated Inversion Recovery Vascular Hyperintensity in Cerebrovascular Disease: A Review for Radiologists and Clinicians

Neuroradiological methods play important roles in neurology, especially in cerebrovascular diseases. Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) is frequently encountered in patients with acute ischemic stroke and significant intracranial arterial stenosis or occlusion. The mechanisms underlying this phenomenon and the clinical implications of FVH have been a matter of debate. FVH is associated with large-vessel occlusion or severe stenosis, as well as impaired hemodynamics. Possible explanations suggested for its appearance include stationary blood and slow antegrade or retrograde filling of the leptomeningeal collateral circulation. However, the prognostic value of the presence of FVH has been controversial. FVH can also be observed in patients with transient ischemic attack (TIA), which may have different pathomechanisms. Its presence can help clinicians to identify patients who have a higher risk of stroke after TIA. In this review article, we aim to describe the mechanism and influencing factors of FVH, as well as its clinical significance in patients with cerebrovascular disease.

Dual Antiplatelet Therapy Using Cilostazol in Patients With Stroke and Intracranial Arterial Stenosis

Background Long‐term benefit of dual antiplatelet therapy (DAPT) over single antiplatelet therapy (SAPT) for the prevention of recurrent stroke has not been established in patients with intracranial arterial stenosis. We compared the efficacy and safety of DAPT with cilostazol and clopidogrel or aspirin to those of SAPT with clopidogrel or aspirin in patients with intracranial arterial stenosis, who were recruited to the Cilostazol Stroke Prevention Study for Antiplatelet Combination trial, a randomized controlled trial in high‐risk Japanese patients with ischemic stroke. Methods and Results We compared the vascular and hemorrhagic events between DAPT and SAPT in patients with ischemic stroke and symptomatic or asymptomatic intracranial arterial stenosis of at least 50% in a major intracranial artery. Patients were placed in two groups: 275 were assigned to receive DAPT and 272 patients SAPT. The risks of ischemic stroke (hazard ratio [HR], 0.47; 95% CI, 0.23–0.95); and composite of stroke, myocardial infarction, and vascular death (HR, 0.48; 95% CI, 0.26–0.91) were lower in DAPT than SAPT, whereas the risk of severe or life‐threatening bleeding (HR, 0.72; 95% CI, 0.12–4.30) did not differ between the 2 treatment groups. Conclusions DAPT using cilostazol was superior to SAPT with clopidogrel or aspirin for the prevention of recurrent stroke and vascular events without increasing bleeding risk among patients with intracranial arterial stenosis after stroke. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01995370.

Non-traditional Lipid Parameters as Potential Predictors of Asymptomatic Intracranial Arterial Stenosis

Background: Intracranial arterial stenosis (ICAS) is a common cause of stroke. Identifying effective predictors of ICAS that could be easily obtained in clinical practice is important. The predictive values of serum individual lipid parameters have been well-established. In recent years, several non-traditional lipid parameters demonstrated greater predictive values for cardiovascular disease and ischemic stroke than traditional individual lipid parameters. However, their effects on asymptomatic ICAS (aICAS) are less clear. Therefore, we sought to observe the effects of non-traditional lipid parameters on aICAS.Methods: We enrolled 5,314 participants from the Asymptomatic Polyvascular Abnormalities in Community study. Asymptomatic ICAS was detected by transcranial Doppler ultrasonography (TCD). Non-traditional lipid parameters, including non-high-density lipoprotein cholesterol (non-HDL-C), the triglycerides/high-density lipoprotein cholesterol ratio (TG/HDL-C), atherogenic coefficient (AC), atherogenic index of plasma, and Castelli's risk index (CRI) were measured. We used multivariable logistic analysis to assess the association of different lipid parameters with aICAS; a trend test and subgroup analyses were also performed.Results: In total, 695 of 5,314 participants had aICAS in this study. For the comparison of the highest to the lowest tertile, the multivariable-adjusted odds ratios (ORs) (95% CIs) were 1.78 (1.39–2.27) (p trend < 0.001) for non-HDL-C, 1.48 (1.18–1.85) (p trend = 0.004) for the AC, 1.48 (1.18–1.85) (p trend = 0.004) for CRI-I, and 1.34 (1.09–1.66) (p trend = 0.032) for CRI-II. Subgroup analyses showed significant interactions between the AC, CRI-I, and diabetes.Conclusions: This large community-based study showed that non-HDL-C, AC, CRI-I, and CRI-II were significantly associated with increased prevalence of aICAS.

Effects Of Early-Stage Blood Pressure Variability On The Functional Outcome In Acute Ischemic Stroke Patients With Symptomatic Intracranial Arterial Stenosis Or Occlusion Receiving Intravenous Thrombolysis

Background: Studies exploring on the relationship between blood pressure fluctuations and outcome in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) are limited. We aimed to investigate the influence of blood pressure variability (BPV) during the first 24 hours after IVT on neurological deterioration (END) and 3-month outcome after IVT in patients with symptomatic intracranial arterial stenosis or occlusion (SIASO).Methods: Clinical data from consecutive AIS patients with SIASO who received IVT were retrospectively analyzed. The hourly systolic BP of all patients were recorded during the first 24 hours following IVT. We calculated three syslolic BPV parameters including coefficient of variability (CV), standard deviation of mean BP (SD) and successive variation (SV). The SV was categorized into four grades based on quartiles. The END was defined as neurological deterioration with an increase in the National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 points within the first 72 hours after admission. Follow-ups was performed at 90 days after onset were performed, and favorable and poor outcome were defined as a modified Rankin Scale scores of ≤1 or ≥2, respectively.Results: A total of 110 patients were included, with a mean age of 62.0 ± 12.5 years. 86 patients (78.2%) were male. Twenty patients (18.2%) experienced END, and 37 patients (33.6%) had a favorable outcome. Compared with patients with in the poor outcome group, age ([64.8 ± 10.9] vs [56.7 ± 13.8]), NIHSS on admission (11.0 [7.0 -16.0] vs 6.0 [3.5 - 9.0]), SV ([14.5 ± 4.3] vs [11.8 ± 3.2]) and SD ([12.7 ± 3.8] vs [10.9 ± 3.3]) were lower in the favorable outcome group (all p < 0.05). No BPV parameters were associated with END. In the multivariable logistic regression analysis, compared with the lowest SV (SV<25% quartile), SV50%-75% (odds rato [OR] = 4.449, 95% confidence interval [CI] = 1.231-16.075, p = 0.023) and SV>75% (OR = 8.676, 95% CI = 1.892-39.775, p = 0.005) were significantly associated with poor outcome at 3 months. Conclusions: SV had a negative relationship with the 3-month outcome in AIS patients with SIASO treated with IVT, indicating that BPV may affect the outcome of AIS.