Cryptogenic Stroke and Nonstenosing Intracranial Calcified Atherosclerosis
Hooman Kamel1, Gino Gialdini2, Hediyeh Baradaran3
1Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York; Department of Neurology, Weill Cornell Medicine, New York, New York.
Summary
Calcified plaques in intracranial large arteries, even without significant narrowing, were more common on the side of stroke in patients with undetermined stroke etiology. This suggests nonstenosing atherosclerosis contributes to cryptogenic strokes.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Radiology
Background:
- Cryptogenic strokes may stem from unrecognized large-artery atherosclerosis causing less than 50% luminal stenosis.
- Intracranial atherosclerotic plaques, particularly nonstenosing ones, are implicated in stroke etiology.
- Imaging biomarkers of calcium burden can quantify atherosclerotic plaque activity.
Purpose of the Study:
- To compare the prevalence of nonstenosing intracranial atherosclerotic plaques ipsilateral to cryptogenic cerebral infarcts versus the unaffected side.
- To investigate the association between calcified intracranial large-artery plaque burden and stroke of undetermined etiology.
Main Methods:
- Prospective stroke registry including patients with cerebral infarction in one internal carotid artery (ICA) territory.
- Comparison of calcification in intracranial ICAs using noncontrast computed tomography (CT) with qualitative and quantitative calcium scoring (Agatston-Janowitz).
- Wilcoxon signed-rank sum test to compare calcium burden in the ipsilateral ICA versus the contralateral ICA within subjects.
Main Results:
- In patients with stroke of undetermined etiology (n=34), greater calcium burden was found in the ICA ipsilateral to the infarction (mean Modified Woodcock Visual Scale score, 6.7) compared to the contralateral side (5.4) (P=.005).
- In patients with cardioembolic stroke (n=21), no significant difference in calcium burden was observed between the ipsilateral ICA (6.7) and contralateral ICA (7.3) (P=.13).
- Quantitative calcium measurements corroborated the findings from qualitative scoring.
Conclusions:
- The burden of calcified intracranial large-artery plaque is associated with downstream cerebral infarction in patients with strokes of undetermined etiology.
- Nonstenosing intracranial atherosclerosis may be an underrecognized cause of cryptogenic stroke.
- Imaging of intracranial arterial calcification is valuable in evaluating patients with cryptogenic stroke.
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