Intracranial Atherosclerotic Disease May Coexist With Stroke Risk Factors

arteriosclerosis, narrowing blood vessels
arteriosclerosis, narrowing blood vessels
Screening for coexisting diseases may help identify high-risk patients with intracranial atherosclerotic disease.

Intracranial atherosclerotic disease (ICAD) commonly coexists with atherosclerosis and several stroke risk factors that may act as markers for guiding risk stratification and improving outcomes, according to study findings from the Asymptomatic Myocardial Ischemia in Stroke and Atherosclerotic Disease study published in JAMA Neurology.

In this single-center, prospective study, investigators followed patients with acute ischemic stroke (n=403) for up to 4 years. Investigators evaluated the prevalence of potential stroke mechanisms and coexisting atherosclerotic burden and their effect on long-term prognosis in patients with stroke and ICAD. The investigators used the atherosclerosis, small-vessel disease, cardiac pathology, other cause, and dissection (ASCOD) grading system to determine the presence of coexistent stroke etiologies.

In 146 (36.2%) patients, significant ICAD (≥50% stenosis/occlusion) was found. Patients with significant ICAD had a higher likelihood of having coronary artery atherosclerosis (76.9% vs 63.2%; P =.007) and aortic arch (60.9% vs 49.0%; P =.04) compared with those without significant ICAD.

Stenosis in both the coronary artery (29.9% vs 12.8%; P =.01; adjusted hazard ratio [aHR], 1.90) and the extracranial carotid artery (23.4% vs 9.0%; P =.08; aHR, 2.12) resulted in an increased risk for major adverse cardiovascular events. Any cardiac pathology (ASCOD grade C1-C3) was also associated with a higher major adverse cardiovascular event risk in patients with ICAD (28.2% vs 11.4%; P =.01; aHR, 2.24). Conversely, patients with ICAD with any type of small vessel disease (grade S1-S3) exhibited a lower risk for major adverse cardiovascular events compared with patients without (17.3% vs 34.6%; P =.05; aHR, 0.23).

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Conventional catheter angiography, which is the recommended method for determining ICAD, was not used in this study, potentially limiting the findings.

Screening for coexisting diseases may help identify high-risk patients with ICAD and assist in guiding “the prognosis and management of patients with strokes that are related to intracranial atherosclerosis.”


Hoshino T, Sissani L, Labreuche J, et al; for the AMISTAD Investigators. Prevalence of systemic atherosclerosis burdens and overlapping stroke etiologies and their associations with long-term vascular prognosis in stroke with intracranial atherosclerotic disease [published online December 26, 2017]. JAMA Neurol. doi: 10.1001/jamaneurol.2017.3960