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. 2021 Aug 10;78(6):562-571.
doi: 10.1016/j.jacc.2021.05.041.

Determinants and Outcomes of Asymptomatic Intracranial Atherosclerotic Stenosis

Jose Gutierrez  1 , Farid Khasiyev  2 , Minghua Liu  3 , Janet T DeRosa  3 , Sarah E Tom  4 , Tatjana Rundek  5 , Ken Cheung  6 , Clinton B Wright  7 , Ralph L Sacco  5 , Mitchell S V Elkind  4
Affiliations

Determinants and Outcomes of Asymptomatic Intracranial Atherosclerotic Stenosis

Jose Gutierrez et al. J Am Coll Cardiol. .

Abstract

Background: Intracranial atherosclerotic stenosis (ICAS) is one of the most common causes of stroke worldwide and confers a high risk of stroke recurrence, despite aggressive management of risk factors.

Objectives: This study identified the role of risk factors and risk of vascular events in subjects with asymptomatic ICAS for improved risk stratification.

Methods: Stroke-free participants in the NOMAS (Northern Manhattan Study) trial, prospectively followed since 1993, underwent a brain magnetic resonance angiogram from 2003 to 2008. The study rated stenosis in 11 brain arteries as: 0: no stenosis; 1: <50% or luminal irregularities; 2: 50%-69%; and 3: ≥70% stenosis or flow gap. The study ascertained vascular events during the post-magnetic resonance imaging (MRI) period. Proportional odds regression quantified the association of pre-MRI exposures, and proportional hazard adjusted models were built to identify the risk of events in the post-MRI period.

Results: The included sample included 1,211 participants from NOMAS (mean age: 71 ± 9 years; 59% women; 65% Hispanic; 45% had any stenosis). Older age (OR: 1.02 per year; 95% CI: 1.01 to 1.04), hypertension duration (OR: 1.01 per year; 95% CI: 1.00 to 1.02), higher number of glucose-lowering drugs (OR: 1.64 per each medication; 95% CI: 1.24 to 2.15), and high-density lipoprotein (OR: 0.96 per mg/dL; 95% CI: 0.92 to 0.99) were associated with ICAS. The highest event risk was noted among participants with ICAS ≥70% (5.5% annual risk of vascular events; HR: 2.1; 95% CI:1.4 to 3.2; compared with those with no ICAS).

Conclusions: ICAS is an imaging marker of established atherosclerotic disease in stroke-free subjects, and incidental diagnosis of ICAS should trigger a thorough assessment of vascular health.

Keywords: arterial stenosis; cerebrovascular disease; intracranial atherosclerosis; risk factor; vascular risk.

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Conflict of interest statement

Funding Support and Author Disclosures This work was supported by the National Institutes of Health (grants R01 AG057709, R01 AG066162, R01 NS36286). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1:
Figure 1:. Timeline of the Northern Manhattan Study longitudinal follow up.
The Northern Manhattan Study (NOMAS) cohort has been followed on average for 18 years with annual interviews and vascular event adjudication by a multidisciplinary team. From 2003-2008, stroke-free participants were invited to undergo a brain MRI.
Central illustration:
Central illustration:. Cumulative incidence of event outcomes by category of stenosis.
The unadjusted cumulative incidence of event outcomes is higher in people with asymptomatic intracranial large artery stenosis compared with those with no stenosis. The highest risk of events is noted among those with >70% stenosis.
See this image and copyright information in PMC

Comment in

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