Morphological Subtypes of Intracranial Internal Carotid Artery Arteriosclerosis and the Risk of Stroke

Background and Purpose: Accumulating evidence highlights the existence of distinct morphological subtypes of intracranial carotid arteriosclerosis. So far, little is known on the prevalence of these subtypes and subsequent stroke risk in the general population. We determined the prevalence of morphological subtypes of intracranial arteriosclerosis and assessed the risk of stroke associated with these subtypes. Methods: Between 2003 and 2006, 2391 stroke-free participants (mean age 69.6, 51.7% women) from the population-based Rotterdam Study underwent noncontrast computed tomography to visualize calcification in the intracranial carotid arteries as a proxy for intracranial arteriosclerosis. Calcification morphology was evaluated according to a validated grading scale and categorized into intimal, internal elastic lamina (IEL), or mixed subtype. Follow-up for stroke was complete until January 1, 2016. We used multivariable Cox regression to assess associations of each subtype with incident stroke. Results: The prevalence of calcification was 82% of which 39% had the intimal subtype, 48% IEL subtype, and 13% a mixed subtype. During a median follow-up of 10.4 years, 155 participants had a stroke. All 3 subtypes were associated with a higher risk of stroke (adjusted hazard ratio [95% CI] for intimal: 2.11 [1.07–4.13], IEL: 2.66 [1.39–5.11], and mixed subtype 2.57 [1.18–5.61]). The association of the IEL subtype with stroke was strongest among older participants. The association of the intimal subtype with stroke was noticeably stronger in women than in men. Conclusions: Calcification of the IEL was the most prevalent subtype of intracranial arteriosclerosis. All 3 subtypes were associated with an increased risk of stroke, with noticeable age and sex-specific differences.

Correlation between Metabolic Syndrome and Intracranial Versus Extracranial Arteriosclerosis among Chinese Patients with Stroke

Background: We aimed to explore the correlation between metabolic syndrome and intracranial and extracranial arteriosclerosis. Overall, 318 over 60-yr-old patients with cerebral infarction or TIA who were examined by digital subtraction angiography (DSA) in our hospital were enrolled in the study. Methods: Overall, 192 patients with intracranial and extracranial arteriosclerosis were admitted to the case group (the intracranial and extracranial arteriosclerosis group). Also, 196 patients, suffering from the same condition, were selected from our outpatient clinic and enrolled in the control group. Results: The prevalence of metabolic syndrome was 31.4%. The prevalence of each metabolic syndrome component in the intracranial arteriosclerosis group was higher than those of the extracranial arteriosclerosis and the control groups. The average component values in the intracranial arteriosclerosis group was higher than those observed in other groups. The prevalence rate of metabolic syndrome had no significant difference among different degrees of stenosis for extracranial arteriosclerosis group. There was a remarkable correlation between intracranial arteriosclerosis and metabolic syndrome (P<0.001), while no correlation was detected between extracranial arteriosclerosis and metabolic syndrome (P<0.001). We concluded that metabolic syndrome may increase the prevalence risk of intracranial arteriosclerosis. There was a significant correlation between intracranial arteriosclerosis and metabolic syndrome components including hyperglycemia and hypertension. Also, there was a significant correlation between extracranial arteriosclerosis and metabolic syndrome components including hyperglycemia. Conclusion: We believe that at least three components of metabolic syndrome can obviously increase the risk of intracranial arteriosclerosis.

Association between Plasma Adipocytokines Levels and Intracranial Versus Extracranial Atherosclerotic Among Chinese Patients with Stroke

Background: To detect the levels of plasma Adipocytokines, TNF-α, IL-6 and PAI-1 in patients with intracranial and extracranial arteriosclerosis. Methods: From September 2015 to September 2017, 318 patients aged ≥60 years were enrolled. Overall, 192 patients were included in the case group (intracranial and extracranial arteriosclerosis group). The 196 outpatients who matched the case groupware selected as the control group. The levels of plasma APN, TNF-α, IL-6 and PAI-1 were measured and their inter- and intra-group comparisons were performed using t-test or analysis of variance. Multivariate logistic regression analysis was used to study the correlation between intracranial arteriosclerosis and extracranial arteriosclerosis. Results: The level of plasma APN in the intracranial and extracranial arteriosclerosis group was significantly lower than that in the control group (P=0.025). The plasma levels of PAI-1, TNF-α and IL-6 were obviously higher than those in the control group (P=0.003, P=0.008, P=0.043). In the intracranial arteriosclerosis group, the level of plasma APN in patients with arterial stenosis ≥70% was significantly lower than that in patients with stenosis 30%-69% (P=0.028). Conclusion: Plasma APN, PAI-1, IL-6 and TNF-α levels can be used as monitoring indicators of intracranial and extracranial arteriosclerosis. Intracranial arteriosclerosis is significantly associated with the decrease of plasma APN level and the increase of plasma PAI- 1, IL-6 and TNF-α levels.

Giant aneurysm of the basilar artery in an 86 year old woman

In this article we present an 80 year old female patient with an unruptured giant aneurysm of the basilar artery presenting with posterior circulation ischemic symptoms. Angiography and CT revealed giant basilar aneurysmal dilatation with severe and wide intracranial arteriosclerosis. We described the uniqueness of this case. Giant basilar aneurysm is associated with various complications particularly brain stem infarction. It is emphasized that arteriosclerosis plays an important role in the formation of giant basilar aneurysms.