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Published on: February 23, 2016

Silent myocardial ischemia in patients with symptomatic intracranial atherosclerosis: associated factors

Juan F Arenillas1, Jaume Candell-Riera, Guillermo Romero-Farina

  • 1Department of Neurology, Vall d'Hebron Universitary Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain. juanfarenillas@terra.es

Stroke
|May 10, 2005
PubMed

Insights

Over half of stroke patients with intracranial atherosclerosis have silent myocardial ischemia. High Lp(a), homocysteine, and specific artery stenoses indicate increased risk for occult coronary artery disease.

Area of Science:

  • Cardiology
  • Neurology
  • Vascular Medicine

Background:

  • Coronary risk evaluation in stroke patients needs optimization.
  • The link between symptomatic intracranial atherosclerosis and hidden coronary artery disease (CAD) is under-researched.

Purpose of the Study:

  • To determine the prevalence of silent myocardial ischemia in patients with symptomatic intracranial atherosclerosis.
  • To identify factors associated with silent myocardial ischemia in this population.

Main Methods:

  • Sixty-five patients with symptomatic intracranial stenosis and no known CAD underwent stress-rest myocardial perfusion single-photon emission computed tomography (SPECT).
  • Lipoprotein(a) [Lp(a)], C-reactive protein, and homocysteine (Hcy) levels were measured.
  • Angiographic confirmation of symptomatic stenosis was required.

Main Results:

  • Myocardial perfusion defects were found in 52% of patients via SPECT.
  • Hypercholesterolemia, multiple risk factors, and elevated Lp(a) and Hcy levels correlated with SPECT abnormalities.
  • Stenosed intracranial internal carotid artery and vertebrobasilar artery stenosis were independently linked to silent ischemia.

Conclusions:

  • Symptomatic intracranial atherosclerosis patients without overt CAD frequently exhibit silent myocardial ischemia.
  • High Lp(a), Hcy levels, and specific intracranial artery stenoses identify patients at higher risk for occult CAD.
Abstract

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