The role of intracranial artery calcification (IAC) in stroke subtype and risk of vascular events,Journal of Stroke & Cerebrovascular Diseases

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The role of intracranial artery calcification (IAC) in stroke subtype and risk of vascular events
Journal of Stroke & Cerebrovascular Diseases ( IF 2.0 ) Pub Date : 2023-05-13 , DOI: 10.1016/j.jstrokecerebrovasdis.2023.107185
Kursat Gurel ₁ , Farid Khasiyev ₂ , Antonio Spagnolo-Allende ₁ , Salwa Rahman ₁ , Minghua Liu ₁ , Erin R Kulick ₃ , Amelia Boehme ₁ , Tatjana Rundek ₄ , Mitchell Sv Elkind ₅ , Randolph S Marshall ₁ , Daniel Bos ₆ , Jose Gutierrez ₁

Affiliation

Florence Irving Assistant Professor of Neurology, Department of Neurology, Irving Medical Center, Vagelos College of Physicians and Surgeons, Columbia University, 710 W 168th Street, 6th floor, Suite 639, New York, NY 10032, United States.
Department of Neurology, Saint Louis University, Saint Louis, MI, United States.
Department of Epidemiology and Biostatatistics, Temple University College of Public Health, Philadelphia, PA, United States.
Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States; Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, United States.
Florence Irving Assistant Professor of Neurology, Department of Neurology, Irving Medical Center, Vagelos College of Physicians and Surgeons, Columbia University, 710 W 168th Street, 6th floor, Suite 639, New York, NY 10032, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.
Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, the Netherlands.

Objective

To test the hypothesis that intracranial arterial calcification (IAC) is associated with intracranial large artery stenosis (ILAS) and a higher risk of vascular events and mortality.

Method

We leveraged data from two cohorts, the New York-Presbyterian Hospital/Columbia University Irving Medical Center Stroke Registry Study (NYP/CUIMC-SRS) and the Northern Manhattan Study (NOMAS) to test our hypotheses. We measured IAC using CT scans of participants in both cohorts and expressed IAC as present (vs not) and in tertiles. For the CUIMC-SRS, demographic, clinical and ILAS status was collected retrospectively. In NOMAS, we used research brain MRI and MRA to define asymptomatic ILAS and covert brain infarcts(CBI). We built models adjusted for demographics and vascular risk factors for cross-sectional and longitudinal analyses.

Results

Cross-sectionally, IAC was associated with ILAS in both cohorts (OR 1.78, 95% CI: 1.16-2.73 for ILAS-related stroke in the NYP/CUIMC-SRS and OR 3.07, 95%CI 1.13-8.35 for ILAS-related covert brain infarcts in NOMAS). In a meta-analysis of both cohorts, IAC in the upper (HR 1.25, 95%CI 1.01-1.55) and middle tertile (HR 1.27, 95%CI 1.01-1.59) was associated with higher mortality compared with participants with no IAC. There were no longitudinal associations between IAC and risk of stroke or other vascular events.

Conclusion

In these multiethnic populations, IAC is associated with symptomatic and asymptomatic ILAS as well as higher mortality. IAC may be a useful marker of higher mortality, the role of IAC as an imaging marker of risk of stroke is less certain.

中文翻译：

颅内动脉钙化（IAC）在卒中亚型和血管事件风险中的作用

客观的

检验颅内动脉钙化 (IAC) 与颅内大动脉狭窄 (ILAS) 以及血管事件和死亡风险较高相关的假设。

方法

我们利用纽约长老会医院/哥伦比亚大学欧文医学中心卒中登记研究 (NYP/CUIMC-SRS) 和北曼哈顿研究 (NOMAS) 这两个队列的数据来检验我们的假设。我们使用两个队列中参与者的 CT 扫描来测量 IAC，并将 IAC 表示为存在（与不存在）和三分位数。对于 CUIMC-SRS，回顾性收集人口统计学、临床和 ILAS 状态。在 NOMAS 中，我们使用研究性脑 MRI 和 MRA 来定义无症状 ILAS 和隐性脑梗塞 (CBI)。我们建立了针对人口统计和血管危险因素进行调整的模型，以进行横断面和纵向分析。

结果

横断面来看，IAC 在两个队列中均与 ILAS 相关（NYP/CUIMC-SRS 中 ILAS 相关卒中的 OR 1.78，95% CI：1.16-2.73，ILAS 相关隐性卒中的 OR 3.07，95% CI 1.13-8.35 NOMAS 中的脑梗塞）。在对两个队列的荟萃分析中，与没有 IAC 的参与者相比，上三分位数（HR 1.25，95% CI 1.01-1.55）和中三分位数（HR 1.27，95% CI 1.01-1.59）的 IAC 与更高的死亡率相关。 IAC 与中风或其他血管事件的风险之间不存在纵向关联。