Morphological Subtypes of Intracranial Internal Carotid Artery Arteriosclerosis and the Risk of Stroke

Morphological Subtypes of Intracranial Internal Carotid Artery Arteriosclerosis and the Risk of Stroke

Van Den Beukel, Tim C. (Erasmus MC)
Van Der Toorn, Janine E. (Erasmus MC)
Vernooij, Meike W. (Erasmus MC)
Kavousi, Maryam (Erasmus MC)
Akyildiz, A.C. (TU Delft Medical Instruments & Bio-Inspired Technology; Erasmus MC)
De Jong, Pim A. (University Medical Center Utrecht)
Van Der Lugt, Aad (Erasmus MC)
Ikram, M. Kamran (Erasmus MC)
Bos, Daniel (Erasmus MC)

2022

Background: Accumulating evidence highlights the existence of distinct morphological subtypes of intracranial carotid arteriosclerosis. So far, little is known on the prevalence of these subtypes and subsequent stroke risk in the general population. We determined the prevalence of morphological subtypes of intracranial arteriosclerosis and assessed the risk of stroke associated with these subtypes. Methods: Between 2003 and 2006, 2391 stroke-free participants (mean age 69.6, 51.7% women) from the population-based Rotterdam Study underwent noncontrast computed tomography to visualize calcification in the intracranial carotid arteries as a proxy for intracranial arteriosclerosis. Calcification morphology was evaluated according to a validated grading scale and categorized into intimal, internal elastic lamina (IEL), or mixed subtype. Follow-up for stroke was complete until January 1, 2016. We used multivariable Cox regression to assess associations of each subtype with incident stroke. Results: The prevalence of calcification was 82% of which 39% had the intimal subtype, 48% IEL subtype, and 13% a mixed subtype. During a median follow-up of 10.4 years, 155 participants had a stroke. All 3 subtypes were associated with a higher risk of stroke (adjusted hazard ratio [95% CI] for intimal: 2.11 [1.07-4.13], IEL: 2.66 [1.39-5.11], and mixed subtype 2.57 [1.18-5.61]). The association of the IEL subtype with stroke was strongest among older participants. The association of the intimal subtype with stroke was noticeably stronger in women than in men. Conclusions: Calcification of the IEL was the most prevalent subtype of intracranial arteriosclerosis. All 3 subtypes were associated with an increased risk of stroke, with noticeable age and sex-specific differences.

carotid arteries
follow-up studies
intracranial arteriosclerosis
multidetector computed tomography
vascular calcification

http://resolver.tudelft.nl/uuid:18ce156f-cfab-4053-b553-b802fec5d626

https://doi.org/10.1161/STROKEAHA.121.036213

0039-2499

Stroke, 53 (4), 1339-1347

Institutional Repository

journal article

© 2022 Tim C. Van Den Beukel, Janine E. Van Der Toorn, Meike W. Vernooij, Maryam Kavousi, A.C. Akyildiz, Pim A. De Jong, Aad Van Der Lugt, M. Kamran Ikram, Daniel Bos