075 Association between intracranial stenosis and extracranial stenosis seen in stroke patients. Issue 6 (24th May 2018)

• Record Type: Journal Article
• Authors: Guduguntla, Geetha; Ting, Cheng Ling; Jain, Tarun; Gawarikar, Yash; Patel, Ronak
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 89:Issue 6(2018)
• Page Start: A30
• Page End: A31
• Publication Date: 2018-05-24
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2018-ANZAN.74
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Introduction: The association between intracranial stenosis (ICS) and extracranial stenosis (ECS) using CT angiography (CTA) and the occurrence of ischaemic stroke and TIA has not yet been fully investigated. This study aimed to investigate if there is a clinically significant relationship between ICS and ECS with stroke and its risk factors, including diabetes, hypertension, hypercholesterolemia, atrial fibrillation (AF) and ischaemic heart disease (IHD). Methods: Four hundred and fifteen consecutive patients that presented to Calvary Public Hospital, Bruce were retrospectively analysed, with 158 excluded for incomplete CTA and MRA results. ICS and ECS severity was based on grading used in the WASID and SAMPRISS trials, while the Fazekas scale was used to grade periventricular white matter disease. CTA findings were used to base the presence and absence of stenosis. Results: ICS and/or ECS was present in 80% with ischaemic stroke, 78% with TIAs but comparatively only in 56% of those diagnosed as 'mimics' (p<0.05). Univariate analysis demonstrated an association between presence of ICS and AF, hypertension, IHD and diabetes (82%, 73%, 84%, 78%; p<0.001) respectively, while for ECS only with AF, hypertension and IHD (77%, 67%, 81%; p<0.001) respectively. Diabetes was independently associated as single biggest risk factor for ICS. Most steno-occlusive lesions were bilateral for ICS and ECS at 80% and 61%, respectively. There also seems to be an association between the presence of ECS and the presence of ICS, with ECS particularly demonstrating predictive value for ICS (ECS PPV for ICS=0.85, chi-square p-value<0.001). Conclusion: These findings suggest a significant association between the presence of ICS and ECS with the occurrence of ischaemic stroke and TIAs as well as with well-known stroke risk factors. This also indicates that perhaps the underlying pathophysiology for steno-occlusive lesions plays a role in ischaemic stroke and warrants further investigating.