Yilmaz Arda, Akpinar Erhan, Topcuoglu Mehmet Akif, Arsava Ethem Murat
Department of Neurology, Faculty of Medicine, Mersin University, Mersin, Turkey.
Neuroradiology. 2015 May;57(5):501-6. doi: 10.1007/s00234-015-1494-8. Epub 2015 Jan 30.
Intracranial internal carotid artery calcifications (ICAC), a frequent finding on imaging studies, are predictive of future stroke risk in population-based studies. The clinical significance of this observation among ischemic stroke patients is however less clear. In this study, we analyzed ICAC burden in relation to vascular risk factor profile, stroke etiology, and extent of craniocervical vascular calcifications in a consecutive series of ischemic stroke patients.
The burden of ICAC was determined both on non-contrast CT and CT-angiography source images by semiquantitative scoring algorithms. The distribution of vascular risk factors, etiologic stroke subtype, and calcification burden in other craniocervical arteries was assessed among patients with no ICAC, mild-moderate ICAC, and severe ICAC.
Of 319 patients included into the study, 28 % had no ICAC, 35 % had mild-moderate ICAC, and 37 % had severe ICAC on CT angiography. Independent factors associated with ICAC burden in multivariate analysis included age (p < 0.001), diabetes mellitus (p = 0.006), and coronary artery disease (p < 0.001). Furthermore, a stroke etiology of large artery atherosclerosis or cardioaortic embolism was significantly related to higher ICAC burden (p = 0.006). Patients with severe ICAC were more likely to harbor calcifications in other vascular beds (p < 0.001). All of these findings persisted when analyses were repeated with CT-based ICAC burden assessments.
ICAC burden reflects a continuum of atherosclerotic disease involving carotid arteries together with other craniocervical vascular beds. ICAC is significantly associated with stroke of large vessel or cardioembolic origin. This information might help the clinician in prioritizing etiologic work-up in the acute period.
颅内颈内动脉钙化（ICAC）在影像学研究中很常见，在基于人群的研究中可预测未来中风风险。然而，这一观察结果在缺血性中风患者中的临床意义尚不清楚。在本研究中，我们分析了一系列连续缺血性中风患者中ICAC负荷与血管危险因素谱、中风病因以及颅颈血管钙化程度之间的关系。
通过半定量评分算法在非增强CT和CT血管造影源图像上确定ICAC负荷。在无ICAC、轻度至中度ICAC和重度ICAC的患者中评估血管危险因素的分布、病因性中风亚型以及其他颅颈动脉的钙化负荷。
在纳入研究的319例患者中，CT血管造影显示28%无ICAC，35%有轻度至中度ICAC，37%有重度ICAC。多变量分析中与ICAC负荷相关的独立因素包括年龄（p<0.001）、糖尿病（p = 0.006）和冠状动脉疾病（p<0.001）。此外，大动脉粥样硬化或心源性主动脉栓塞的中风病因与较高的ICAC负荷显著相关（p = 0.006）。重度ICAC患者在其他血管床更易出现钙化（p<0.001）。当用基于CT的ICAC负荷评估重复分析时，所有这些发现均持续存在。
ICAC负荷反映了涉及颈动脉以及其他颅颈血管床的动脉粥样硬化疾病的连续情况。ICAC与大血管或心源性栓塞性中风显著相关。这些信息可能有助于临床医生在急性期优先进行病因检查。
