Risk factors for atherosclerotic and medial arterial calcification of the intracranial internal carotid artery. (September 2018)

• Record Type: Journal Article
• Authors: Vos, Annelotte; Kockelkoren, Remko; de Vis, Jill B.; van der Schouw, Yvonne T.; van der Schaaf, Irene C.; Velthuis, Birgitta K.; Mali, Willem P.T.M.; de Jong, Pim A.
• Is Part Of: Atherosclerosis. Volume 276(2018)
• Page Start: 44
• Page End: 49
• Publication Date: 2018-09
• Subjects: Intracranial carotid artery -- Cardiovascular disease risk factors -- Medial arterial calcification -- Atherosclerosis; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2018.07.008
• Languages: English
• ISSNs: 0021-9150

Abstract

Abstract: Background and aims: Calcifications of the intracranial internal carotid artery (iICA) are an important risk factor for stroke. The calcifications can occur both in the intimal and medial layer of the vascular wall. The aim of this study is to assess whether medial calcification in the iICA is differently related to risk factors for cardiovascular disease, compared to intimal calcification. Methods: Unenhanced thin slice computed tomography (CT) scans from 1132 patients from the Dutch acute stroke study cohort were assessed for dominant localization of calcification (medial or intimal) by one of three observers based on established methodology. Associations between known cardiovascular risk factors (age, gender, body mass index, pulse pressure, eGFR, smoking, hypertension, diabetes mellitus, hyperlipidemia, previous vascular disease, and family history) and the dominant localization of calcifications were assessed via logistic regression analysis. Results: In the 1132 patients (57% males, mean age 67.4 years [SD 13.8]), dominant intimal calcification was present in 30.9% and dominant medial calcification in 46.9%. In 10.5%, no calcification was seen. Age, pulse pressure and family history were risk factors for both types of calcification. Multivariably adjusted risk factors for dominant intimal calcification only were smoking (OR 2.09 [CI 1.27–3.44]) and hypertension (OR 2.09 [CI 1.29–3.40]) and for dominant medial calcification diabetes mellitus (OR 2.39 [CI 1.11–5.14]) and previous vascular disease (OR 2.20 [CI 1.30–3.75]). Conclusions: Risk factors are differently related to the dominant localizations of calcifications, a finding that supports the hypothesis that the intimal and medial calcification represents a distinct etiology. Highlights: Dominant intimal and medial arterial calcification were distinguished on CT using a novel visual score. Both dominant intimal and medial calcification were related to age, pulse pressure and positive family history. Dominant intimal calcification was related to smoking and hypertension. Dominant medial calcification was related to diabetes mellitus and previous vascular disease. Different associations with risk factors support the hypothesis of a different etiology for intimal and medial calcification.