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Quantitative CTA vascular calcification, atherosclerosis burden, and stroke mechanism in patients with ischemic

Takashi Shimoyama1, Sibaji Gaj2, Kunio Nakamura2

  • 1Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.

Journal of the Neurological Sciences
|May 6, 2023
PubMed

Insights

Vascular calcification quantification via CT angiography helps identify large artery atherosclerosis (LAA) as a stroke cause, particularly in younger patients. Higher calcification volumes in major vessels indicate LAA in this demographic.

Area of Science:

  • Cardiovascular Imaging
  • Neurology
  • Radiology

Background:

  • Vascular calcification is an advanced marker of atherosclerosis.
  • Differentiating stroke etiologies is crucial for effective treatment.
  • CT angiography (CTA) offers detailed vascular imaging.

Purpose of the Study:

  • To investigate if vascular calcium quantification in CTA can distinguish large artery atherosclerosis (LAA) from other stroke causes.
  • To analyze the correlation between calcification patterns and stroke etiology across different age groups.

Main Methods:

  • 375 acute ischemic stroke patients underwent complete CTA.
  • Deep-learning and region-growing algorithms segmented arteries and calcifications.
  • Calcification volumes were measured in the intracranial internal carotid artery, cervical carotid artery, and aortic arch.
  • Vascular calcification patterns were analyzed by age: young (<65), intermediate (65-74), and older (≥75).

Main Results:

  • 25.3% of patients were diagnosed with LAA.
  • Calcification volumes increased with age in all measured vessel beds.
  • In younger patients, significantly higher calcification volumes were observed in all analyzed vessels for LAA compared to other stroke subtypes.
  • Calcification volumes in intracranial ICA, cervical carotid artery, and aorta were independently associated with LAA in younger patients.
  • No significant association between calcification volumes and stroke subtypes was found in intermediate or older age groups.

Conclusions:

  • Atherosclerosis calcium volumes in major vessels are significantly higher in large artery atherosclerosis (LAA) stroke compared to non-LAA stroke in younger individuals.
  • CTA-based vascular calcification quantification may serve as a valuable tool for identifying LAA in younger stroke patients.
Abstract

Keywords:
AngiographyAtherosclerosisCerebral infarctionDeep-learning U-net modelVascular calcification

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