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Published on: June 18, 2021
Intracranial carotid arteriosclerosis and their prognosis in intracerebral hemorrhage
Bo-Ching Lee1,2, Hsin-Hsi Tsai3, Ya-Fang Chen1
1Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
Insights
Intracranial carotid artery calcification (ICAC) is common in intracerebral hemorrhage (ICH) survivors. Internal elastic lamina (IEL) calcification, a subtype of ICAC, is linked to increased risks of stroke and mortality.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Background:
- Intracerebral hemorrhage (ICH) survivors face elevated risks of future vascular events.
- Intracranial carotid artery calcification (ICAC) is a marker of arteriosclerosis and a stroke risk factor, but its role in ICH survivors is unclear.
Purpose of the Study:
- To determine the prevalence and morphological subtypes of ICAC in ICH survivors.
- To investigate the association between ICAC subtypes and long-term vascular events.
Main Methods:
- Retrospective analysis of spontaneous ICH survivors treated at a single center.
- Assessment of ICAC morphology (intimal, internal elastic lamina (IEL), or mixed) using non-contrast CT.
- Two-year follow-up to record vascular events (stroke, cardiovascular events, death) using multivariable Cox regression.
Main Results:
- ICAC was present in 80.1% of ICH survivors.
- Internal elastic lamina (IEL) calcification was associated with older age, diabetes, and reduced renal function.
- IEL calcification significantly increased the risk of ischemic stroke (HR=9.0), vascular mortality (HR=13.6), and all-cause mortality (HR=13.9) over two years.
Conclusions:
- Intracranial carotid artery calcification (ICAC) is highly prevalent in intracerebral hemorrhage (ICH) survivors.
- The internal elastic lamina (IEL) calcification subtype shows prognostic value for long-term vascular events in ICH survivors.
Background:
Intracerebral hemorrhage (ICH) is a manifestations of sporadic cerebral small vessel disease, and the survivors are predisposed to higher long-term risks of vascular events. Intracranial carotid artery calcification (ICAC), a potential marker for arteriosclerosis, is a risk factor for stroke but their roles in ICH is unknown. We aimed to investigate the prevalence and morphological subtypes of ICAC and their associations with long-term vascular events in ICH survivors.
Materials And Methods:
Survivors of spontaneous ICH treated at a single center in Taiwan were included. ICAC was assessed by non-contrast CT; morphology was evaluated and categorized as intimal, internal elastic lamina (IEL), or mixed subtype. Patients were followed up for two years. Associations between calcification subtypes and follow-up events (stroke, cardiovascular event, death) were explored using multivariable Cox regression models.
Results:
Overall, 462 (80.1%) survivors of ICH had ICAC-223 (38.6%) were categorized as IEL calcification, 216 (37.4%) as intimal calcification, and 23 (4.0%) as mixed type calcification-and 115 patients (19.9%) had no calcification. Patients with IEL calcification were older than patients with intimal or no calcification (p < 0.001). Age (p < 0.001), diabetes (p = 0.010), and reduced renal function (p = 0.001) were independently associated with IEL calcification. During 2-years of follow-up, IEL calcification was not associated with a significant difference in the risk of recurrent ICH (HR=2.8 [0.8‒9.7]), but was associated with higher risks of incident ischemic stroke (HR = 9.0 [1.0‒77.4]), vascular mortality (HR = 13.6 [1.7‒1772.4], and all-cause mortality (HR = 13.9 [1.8‒105.8]).
Conclusions:
ICAC is common among ICH survivors and the subtype of IEL calcification may potentially have prognostic value for long-term vascular events.
