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.
J Stroke Cerebrovasc Dis. 2023 Aug;32(8):107185. doi: 10.1016/j.jstrokecerebrovasdis.2023.107185. Epub 2023 May 13.
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.
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.
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.
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.
验证颅内动脉钙化（IAC）与颅内大动脉狭窄（ILAS）及更高的血管事件和死亡率风险相关的假设。
我们利用来自两个队列的数据，即纽约长老会医院/哥伦比亚大学欧文医学中心卒中登记研究（NYP/CUIMC-SRS）和北部曼哈顿研究（NOMAS）来检验我们的假设。我们使用这两个队列参与者的 CT 扫描来测量 IAC，并将 IAC 表示为存在（vs 不存在）和分为三分位。对于 CUIMC-SRS，我们回顾性地收集了人口统计学、临床和 ILAS 状况。在 NOMAS 中，我们使用研究性脑 MRI 和 MRA 来定义无症状性 ILAS 和隐匿性脑梗死（CBI）。我们建立了调整人口统计学和血管危险因素的模型，用于横断面和纵向分析。
在两个队列中，IAC 与 ILAS 均有关联（NYP/CUIMC-SRS 中与 ILAS 相关的卒中的 OR 为 1.78，95%CI：1.16-2.73，而在 NOMAS 中与 ILAS 相关的隐匿性脑梗死的 OR 为 3.07，95%CI：1.13-8.35）。在对两个队列的荟萃分析中，与无 IAC 的参与者相比，上（HR 1.25，95%CI 1.01-1.55）和中三分位（HR 1.27，95%CI 1.01-1.59）的 IAC 与更高的死亡率相关。在 IAC 与卒中或其他血管事件风险的纵向关联中没有发现任何关联。
在这些多种族人群中，IAC 与有症状和无症状性 ILAS 以及更高的死亡率相关。IAC 可能是更高死亡率的有用标志物，而 IAC 作为卒中风险的影像学标志物的作用则不太确定。
