Mine Hayriye SORGUN, Canan TOGAY IŞIKAY, Çağrı ULUKAN, Sabiha TEZCAN, Hafize ÇOTUR, Sefer RZAYEV, Anwar RAWANDI, Müge KUZU, Volkan YILMAZ, İnci Şule ÖZER

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

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.

PDF

___

1. Feldmann E, Daneault N, Kwan E, Ho KJ, Pessin MS, Langerberg P, Caplan LR. Chinese-white differences in the distribution of occlusive cerebrovascular disease. Neurology 1990; 40: 1541-1545.
2. Leung SY, Ng TH, Yuen ST, Lauder IJ, Ho FC. Pattern of cerebral atherosclerosis in Hong Kong Chinese. Severity in intracranial and extracranial vessels. Stroke 1993; 24: 779-786.
3. Sacco RL, Kargman DE, Gu Q, Zamanillo MC. Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke 1995; 26: 14-20.
4. Liu HM, Tu YK, Yip PK, Su CT. Evaluation of intracranial and extracranial carotid steno-occlusive diseases in Taiwan Chinese patients with MR angiography: preliminary experience. Stroke 1996; 27: 650-653.
5. Huang YN, Gao S, Li SW, Huang Y, Li JF, Wong KS, Kay R. Vascular lesions in Chinese patients with transient ischemic attacks. Neurology 1997; 48: 524-525.
6. Wong KS, Huang YN, Gao S, Lam WW, Chan YL, Kay R. Intracranial stenosis in Chinese patients with acute stroke. Neurology 1998; 50: 812-813.
7. Wong KS, Li H, Chan YL, Ahuja A, Lam WW, Wong A, Kay R. Use of transcranial Doppler ultrasound to predict outcome in patients with intracranial large-artery occlusive disease. Stroke 2000; 31: 2641-2647.
8. Wang GH, Wang YJ, Jiang WJ. Distribution of cerebral artery stenosis in patients with ischemic cerebrovascular disease. Chin J Geriatr Cardiovasc Cerebrovasc Dis 2003; 5: 315-317.
9. Shi HZ, Li D, Li SM, Ling F. Analysis of the etiologic factors in 1000 Chinese patients with ischemia cerebrovascular disease by DSA. Chin J Cererbrovasc Dis 2005; 2: 437-440.
10. Weimar C, Goertler M, Harms L, Diener HC. Distribution and outcome of symptomatic stenoses and occlusions in patients with acute cerebral ischemia. Arch Neurol 2006; 63: 1287-1291.
11. De Silva DA, Woon FP, Lee MP, Chen CP, Chang HM, Wong MC. South Asian patients with ischemic stroke: intracranial large arteries are the predominant site of disease. Stroke 2007; 38: 2592-2594.
12. Weber R, Kraywinkel K, Diener HC, Weimar C; German Stroke Study Collaboration. Symptomatic intracranial atherosclerotic stenoses: prevalence and prognosis in patients with acute cerebral ischemia. Cerebrovasc Dis 2010; 30: 188-193.
13. Meseguer E, Lavallée PC, Mazighi M, Labreuche J, Cabrejo L, Olivot JM, Abboud H, Slaoui T, Lapergue B, Guidoux C et al. Yield of systematic transcranial Doppler in patients with transient ischemic attack. Ann Neurol 2010; 68: 9-17.
14. Tsivgoulis G, Vadikolias K, Heliopoulos I, Katsibari C, Voumvourakis K, Tsakaldimi S, Boutati E, Vasdekis SN, Athanasiadis D, Al-Attas OS et al. Prevalence of symptomatic intracranial atherosclerosis in Caucasians: a prospective, multicenter, transcranial Doppler study. J Neuroimaging 2012; 24: 11-17.
15. Logallo N, Naess H, Waje-Andreassen U, Thomassen L. Prevalence of intracranial stenosis in a Norwegian ischemic stroke population. J Stroke Cerebrovasc Dis 2014; 23: 1611- 1615.
16. Alkan O, Kizilkilic O, Yildirim T, Atalay H. Intracranial cerebral artery stenosis with associated coronary artery and extracranial carotid artery stenosis in Turkish patients. Eur J Radiol 2009; 71: 450-455.
17. Liu Y, Huang Y, Wang B. Intracranial artery occlusive diseases in patients with hypertension and diabetes mellitus. Zhonghua Yi Xue Za Zhi 2001; 81: 1387-1389.
18. Thomas GN, Lin JW, Lam WW, Tomlinson B, Yeung V, Chan JC, Liu R, Wong KS. Increasing severity of cardiovascular risk factors with increasing middle cerebral artery stenotic involvement in type 2 diabetic Chinese patients with asymptomatic cerebrovascular disease. Diabetes Care 2004; 27: 1121-1126.
19. Arenillas JF, Molina CA, Chacon P, Rovira A, Montaner J, Coscojuela P, Sánchez E, Quintana M, Alvarez-Sabín J. High lipoprotein (a), diabetes, and the extent of symptomatic intracranial atherosclerosis. Neurology 2004; 63: 27-32.
20. Wong KS, Huang YN, Yang HB, Gao S, Li H, Liu JY, Liu Y, Tang A. A door-to-door survey of intracranial atherosclerosis in Liangbei County, China. Neurology 2007; 68: 2031-2034.
21. Wong KS, Ng PW, Tang A, Liu R, Yeung V, Tomlinson B. Prevalence of asymptomatic intracranial atherosclerosis in high-risk patients. Neurology 2007; 68: 2035-2038.
22. Chimowitz MI, Kokkinos J, Strong J, Brown MB, Levine SR, Silliman S, Pessin MS, Weichel E, Sila CA, Furlan AJ et al; for the Warfarin-Aspirin Symptomatic Intracranial Disease Study Group. The Warfarin-Aspirin Symptomatic Intracranial Disease Study. Neurology 1995; 45: 1488-1493.
23. Ay H, Furie KL, Singhal A, Smith WS, Sorensen AG, Koroshetz WJ. An evidence-based causative classification system for acute ischemic stroke. Ann Neurol 2005; 58: 688-697.
24. Mazighi M, Tanasescu R, Ducrocq X, Vicaut E, Bracard S, Houdart E, Woimant F. Prospective study of symptomatic atherothrombotic intracranial stenoses: the GESICA study. Neurology 2006; 66: 1187-1191.
25. Zhang JH, Liu JY. The analysis of the relationship between metabolic syndrome and intra-and extracranial atherosclerotic stenosis. J Brain Nervous Dis 2008; 16: 406-409.
26. Huang HW, Guo MH, Lin RJ, Chen YL, Luo Q, Zhang Y, Wong KS. Prevalence and risk factors of middle cerebral artery stenosis in asymptomatic residents in Rongqi County, Guangdong. Cerebrovasc Dis 2007; 24: 111-115.