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Intracranial Internal Carotid Artery Wall Calcification in Ischemic Strokes Treated with Thrombolysis
Miguel Tábuas-Pereira1, João Sargento-Freitas1, Fernando Silva1
1Stroke Unit, Centro Hospitalar e Universitário de Coimbra, CHUC, Coimbra, Portugal.
Insights
Intracranial carotid artery calcification in stroke patients does not predict hemorrhage or good outcomes but is linked to increased mortality. This finding is crucial for understanding stroke risk and patient prognosis.
Area of Science:
- Neurology
- Cardiovascular Research
- Medical Imaging
Background:
- Atherosclerotic plaques frequently contain calcifications, serving as markers for atherosclerosis and predictors of clinical outcomes in various vascular regions.
- Computed tomography (CT) scans are effective in detecting intracranial arterial calcifications in patients experiencing acute ischemic stroke.
Purpose of the Study:
- To examine the relationship between calcification in the intracranial internal carotid artery and functional outcomes, symptomatic intracerebral hemorrhage (sICH), recanalization, and mortality.
- To assess if intracranial internal carotid artery calcification influences the risk of sICH after thrombolysis.
Main Methods:
- A cohort of 396 ischemic stroke patients receiving recombinant tissue plasminogen activator (rTPA) between January 2011 and September 2014 was analyzed.
- Admission CT scans were used to quantify the Total Carotid Syphon Calcification score.
- Patients were followed for at least 6 months, with outcomes including recanalization, sICH, and functional status (modified Rankin Scale) at 3 months.
Main Results:
- Calcification of the carotid artery wall did not predict sICH, recanalization, or favorable functional outcomes.
- However, carotid artery wall calcification was a significant predictor of mortality (OR 1.102, 95% CI [1.004-1.211], p = 0.042).
Conclusions:
- Intracranial carotid artery calcification does not elevate the risk of thrombolysis-induced symptomatic intracerebral hemorrhage.
- A higher degree of carotid artery wall calcification may be associated with an increased rate of mortality in ischemic stroke patients.
Background:
Calcifications are an important element of atherosclerotic plaques and have been used as a marker of atherosclerosis and clinical outcome predictor in different vascular territories. CT-scan, performed in the acute ischemic stroke setting, can reliably detect intracranial arterial calcifications.
Objectives:
To investigate the association between intracranial internal carotid artery calcification and functional outcome, symptomatic intracerebral hemorrhage (sICH), recanalization, and death.
Methods:
We included 396 consecutive ischemic stroke patients submitted to recombinant tissue plasminogen activator treatment between January 2011 and September 2014. Admission CT-scans were reviewed to calculate the Total Carotid Syphon Calcification score. Patients were followed for up to at least 6 months post-stroke or until death. Outcome measures included evaluation of recanalization on the first 24 h (transcranial color coded Doppler or angio-CT), sICH, and assessment of functional outcome at 3 months after stroke (using modified Rankin scale).
Results:
Carotid artery wall calcification did not predict sICH, recanalization or any good outcome. However, it was a statistically significant predictor of death (OR 1.102, 95% CI [1.004-1.211], p = 0.042).
Discussion:
Intracranial carotid artery calcification does not increase the risk of thrombolysis-induced sICH. Patients with higher grade of carotid artery wall calcification may have a higher mortality rate.
