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Distribution Pattern of Atherosclerotic Stenosis in Chinese Patients with Stroke: A Multicenter Registry Study

Yang Hua¹, Lingyun Jia¹, Yingqi Xing²

¹1Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, China.

Aging and Disease

|February 2, 2019

Insights

Atherosclerotic stenosis in Chinese ischemic stroke patients predominantly affects intracranial and anterior circulation arteries. This pattern shifts with aging, with increased extracranial involvement and varying risk factors like hypertension and smoking.

Area of Science:

Neurology
Vascular Medicine
Epidemiology

Background:

Atherosclerotic stenosis is a major cause of ischemic stroke.
Understanding its distribution in different arterial beds and its evolution with age is crucial for effective prevention and treatment.

Purpose of the Study:

To investigate the distribution patterns of atherosclerotic stenosis in extracranial and intracranial arteries, and in anterior versus posterior circulations.
To analyze the trends of these patterns with aging in Chinese patients with ischemic stroke.
To identify risk factors associated with these distribution patterns.

Main Methods:

Multicenter study involving 9,346 hospitalized ischemic stroke patients.
Utilized carotid artery ultrasonography and transcranial Doppler sonography for arterial evaluation.
Employed logistic regression to analyze distribution patterns and risk factors.

Main Results:

30.8% of patients had stenosis ≥50%.
Intracranial arteries (52.6%) and anterior circulation arteries (52.2%) were more frequently affected than extracranial (27.6%) or posterior circulation arteries (26.2%).
With aging, intracranial stenosis decreased while extracranial and combined stenosis increased. Hypertension, family history, male sex, smoking, and aging were identified as risk factors.

Conclusions:

Intracranial and anterior circulation arteries are primary sites of atherosclerotic stenosis in Chinese ischemic stroke patients.
The distribution pattern of stenosis is dynamic, changing with age and influenced by various risk factors.
Targeted interventions considering age and specific risk factors are warranted.

Read full analysis

Abstract:

The aim of this multicenter study was to demonstrate the distribution pattern of atherosclerotic stenosis and its trend with aging between extracranial and intracranial arteries and its distribution between the anterior and posterior circulations in Chinese patients hospitalized with ischemic stroke. In addition, the risk factors for the distribution pattern were illustrated. From June 2015 to May 2016, 9,346 patients with ischemic stroke from 20 hospitals were enrolled. Carotid artery ultrasonography and transcranial color-coded sonography/transcranial Doppler were used to evaluate the extracranial and intracranial arteries. The distribution pattern of atherosclerotic stenosis and its trend with aging were analyzed. Logistic regression was used to analyze the risk factors for the distribution pattern. Among the 9,346 patients, 2,882 patients (30.8%) had at least one artery with a degree of stenosis ≥50%. Among patients with arterial stenosis, the proportion of patients with intracranial artery stenosis was higher than those with extracranial artery stenosis (52.6% vs. 27.6%), and the proportion of anterior circulation artery stenosis was higher than that in the posterior circulation (52.2% vs.26.2%). With aging, the proportion of intracranial artery stenosis alone decreased; at the same time, the proportion of extracranial artery stenosis and extracranial plus intracranial artery stenosis increased (trend χ²=6.698, P=0.001). Hypertension (OR 1.416, P=0.008) and family history of stroke (OR 1.479, P=0.014) were risk factors for intracranial artery stenosis. Male, aging, and smoking were factors more related to extracranial artery stenosis. Aging (OR 1.022, P<0.001) and hypertension (OR 1.392, P=0.019) were related to posterior circulation artery stenosis. Intracranial arteries and anterior circulation arteries were susceptible to stenosis in Chinese patients with ischemic stroke. However, the distribution pattern of atherosclerotic stenosis was dynamic and varied with aging. Aging and different risk factors contribute to this distribution pattern.

Keywords:

Atherosclerosis Chinese Distribution Ischemic stroke Risk factor Vascular Ultrasound

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