Hoshino T, et al. - Physicians designed this study to explain the prevalence of systemic atherosclerotic burdens and overlapping stroke etiologies and their contributions to long-term prognoses among patients who have experienced stroke with intracranial atherosclerotic disease (ICAD). Coexisting systemic atherosclerosis and multiple potential stroke mechanisms were often noted in patients with ICAD that affected their prognosis. Thus, findings revealed that extensive evaluations of overlapping diseases could allow better risk stratification.

Methods

• The design of this Asymptomatic Myocardial Ischemia in Stroke and Atherosclerotic Disease study was a single-center prospective research.
• A total of 405 patients with acute ischemic stroke within 10 days of onset were consecutively enrolled between June 2005 and December 2008 and followed up for 4 years.
• In this analysis, 403 patients were included for assessment after excluding 2 patients because of incomplete investigations.
• The physicians defined significant ICAD as having 50% or greater stenosis/occlusion by contrast-enhanced/time-of-flight magnetic resonance angiography, computed tomography angiography, and/or transcranial Doppler ultrasonography.
• They performed systemic vascular investigations on atherosclerotic disease with ultrasonography in carotid arteries, aorta and femoral arteries, and by angiography in coronary arteries.
• Using the atherosclerosis, small-vessel disease, cardiac pathology, other cause, and dissection (ASCOD) grading system, coexistent stroke etiologies were evaluated.
• In this study, they estimated the 4-year risk of major adverse cardiovascular events (MACE), including vascular death, nonfatal cardiac events, nonfatal stroke, and major peripheral arterial events.

Results

• Among 403 participants, 298 (74%) were men and the mean (SD) age was 62.6 (13.1) years.
• The physicians found significant ICAD in 146 (36.2%).
• Patients with significant ICAD, compared to those without, more often had aortic arch (70 [60.9%] vs 99 [49.0%]; P=.04) and coronary artery (103 [76.9%] vs 153 [63.2%]; P=.007) atherosclerosis.
• Concurrent stenosis in the extracranial carotid artery (24 [23.4%] vs 3 [9.0%]; P=.08; adjusted hazard ratio[aHR] = 2.12) and the coronary artery (19 [29.9%] vs 8 [12.8%]; P=.01; aHR = 1.90) increased the MACE risk among patients with ICAD.
• Moreover, patients with ICAD who also had any cardiac pathology (ASCOD grade C1-3) were found to be at a higher MACE risk than others (grade C0) (20 [28.2%] vs 7 [11.4%]; P=.01; aHR = 2.24).
• On the other hand, patients with ICAD with any form of small vessel disease (grade S1-3) reported a lower MACE risk than those without (grade S0) (20 [17.3%] vs 6 [34.6%]; P=.05; aHR = 0.23).