Inflammatory markers, rather than conventional risk factors, are different between carotid and MCA atherosclerosis
1Department of Neurology, College of Medicine, Ajou University, Woncheon-dong San 5, Suwon, Kyungki-do, 442-749, Republic of Korea. nmboy@unitel.co.kr
Insights
Inflammation markers, not conventional factors, differentiate carotid and middle cerebral artery (MCA) atherosclerosis in stroke patients. MCA plaques may be more stable than carotid plaques, impacting stroke mechanisms.
Area of Science:
- Neuroscience
- Vascular Biology
- Inflammation Research
Background:
- Differences in risk factors for intra- and extracranial atherosclerosis remain unclear.
- Mechanisms underlying strokes in intracranial atherosclerosis are not well understood.
- Investigated conventional and other factors in stroke patients with large artery atherosclerosis.
Purpose of the Study:
- To investigate differences in risk factors and stroke mechanisms between carotid and middle cerebral artery (MCA) atherosclerosis.
- To compare clinical features, risk factors, and diffusion-weighted imaging (DWI) patterns between patient groups.
Main Methods:
- Selected patients with acute non-cardioembolic cerebral infarcts in the MCA territory using DWI and vascular/cardiologic studies.
- Divided patients into groups based on atherosclerotic lesions: carotid sinus (n=112) vs. isolated proximal MCA (n=160).
- Compared clinical features, risk factors, and DWI patterns between the two groups.
Main Results:
- No differences in conventional risk factors were found between groups.
- Inflammatory markers were significantly higher in carotid atherosclerosis patients compared to isolated MCA atherosclerosis patients (p < 0.01).
- Higher C-reactive protein levels correlated inversely with MCA atherosclerosis (OR 0.57; p=0.02). Internal borderzone infarcts (hemodynamic) were common in MCA occlusion, while territorial infarcts (plaque rupture) were common in carotid occlusion.
Conclusions:
- Inflammatory markers, not conventional risk factors, distinguish clinical and radiological differences between carotid and MCA atherosclerosis.
- Plaques associated with MCA atherosclerosis may be more stable than those associated with carotid atherosclerosis.
- Findings suggest distinct pathophysiological mechanisms for intra- and extracranial large artery atherosclerosis.
Background:
The apparent differences in risk factors for intra- and extracranial atherosclerosis are unclear and the mechanisms that underlie strokes in patients with intracranial atherosclerosis are not well known. We investigated the conventional vascular risk factors as well as other factors in stroke patients with large artery atherosclerosis.
Methods:
Using diffusion weighted imaging (DWI) and vascular and cardiologic studies, we selected patients with acute non-cardioembolic cerebral infarcts within the middle cerebral artery (MCA) territory. Patients were divided into two groups: those with atherosclerotic lesions on the carotid sinus (n = 112) and those with isolated lesions on the proximal MCA (n = 160). Clinical features, risk factors, and DWI patterns were compared between groups.
Results:
There were no differences in conventional risk factors, but markers for inflammation were significantly higher in patients with carotid atherosclerosis than in those with isolated MCA atherosclerosis (p < 0.01 for both). After adjustments for age/sex and the severity of stroke, an inverse correlation was observed between C-reactive protein levels and MCA atherosclerosis (odds ratio 0.57 per 1 mg/dl increase; 95% confidence interval 0.35 to 0.92; p = 0.02). Internal borderzone infarcts suggestive of haemodynamic causes were the most frequent DWI pattern in patients with MCA occlusion, whereas territorial infarcts suggesting plaque ruptures were most common in those with carotid occlusion.
Conclusions:
Our results indicate that inflammatory markers, rather than conventional risk factors, reveal clinical and radiological differences between patients with carotid and MCA atherosclerosis. Plaques associated with MCA atherosclerosis may be more stable than those associated with carotid atherosclerosis.
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