Middle Cerebral Artery Calcification: Association With Ischemic Stroke
Hung-Wen Kao1, Michelle Liou, Hsiao-Wen Chung
1From the Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (H-WK, H-WC, S-WC, G-SH, H-HH, C-YC); Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan (H-WK); Institute of Statistical Science, Academia, Taipei, Taiwan Sinica (ML); Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan (H-WC, S-WC); Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan (H-SL, P-HT, C-YC); Imaging Research Center, Taipei Medical University, Taipei, Taiwan (H-SL, P-HT, C-YC); Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan (H-SL, P-HT, C-YC); Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (M-CC); and Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (G-SP)..
Abstract:
Calcification of the middle cerebral artery (MCA) is uncommon in the healthy elderly. Whether calcification of the MCA is associated with cerebral ischemic stroke remains undetermined. We intended to investigate the association using Agatston calcium scoring of the MCA. This study retrospectively included 354 subjects with ischemic stroke in the MCA territory and 1518 control subjects who underwent computed tomography (CT) of the brain. We recorded major known risk factors for ischemic stroke, including age, gender, hypertension, diabetes mellitus, smoking, hyperlipidemia, and obesity, along with the MCA calcium burden, measured with the Agatston calcium scoring method. Univariate and modified logistic regression analyses were performed to examine the association between the MCA calcification and ischemic stroke. The univariate analyses showed significant associations of ischemic stroke with age, hypertension, diabetes mellitus, smoking, total MCA Agatston score, and the presence of calcification on both or either side of the MCA. Subjects with the presence of MCA calcification on both or either side of the MCA were 8.46 times (95% confidence interval, 4.93-14.53; P < 0.001) more likely to have a cerebral infarct than subjects without MCA calcification after adjustment for the major known risk factors, including age, hypertension, diabetes mellitus, and smoking. However, a higher degree of MCA calcification reflected by the Agatston score was not associated with higher risk of MCA ischemic stroke after adjustment for the confounding factors and presence of MCA calcification. These results suggest that MCA calcification is associated with ischemic stroke in the MCA territory. Further prospective studies are required to verify the clinical implications of the MCA calcification.
Insights
Calcification in the middle cerebral artery (MCA) is linked to ischemic stroke. Presence of MCA calcification significantly increases stroke risk, though the degree of calcification may not further elevate risk.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Calcification of the middle cerebral artery (MCA) is not common in healthy older adults.
- The relationship between MCA calcification and cerebral ischemic stroke is not well-established.
Purpose of the Study:
- To investigate the association between MCA calcification and ischemic stroke in the MCA territory.
- To utilize Agatston calcium scoring for quantifying MCA calcification burden.
Main Methods:
- Retrospective study including 354 ischemic stroke patients and 1518 controls.
- Computed tomography (CT) scans were used to assess MCA calcification via Agatston scoring.
- Logistic regression analysis adjusted for major stroke risk factors.
Main Results:
- Univariate analysis revealed associations between ischemic stroke and age, hypertension, diabetes, smoking, and MCA calcification.
- MCA calcification (on either or both sides) was associated with an 8.46-fold increased likelihood of cerebral infarct.
- Higher Agatston scores did not correlate with increased stroke risk after adjusting for calcification presence and other factors.
Conclusions:
- MCA calcification is significantly associated with ischemic stroke in the MCA territory.
- The mere presence of MCA calcification, rather than its severity, appears to be the key risk factor.
- Further prospective research is needed to confirm clinical implications.
