title: Inflammatory markers, rather than conventional risk factors, are different between carotid and MCA atherosclerosis.
abstract: BACKGROUND
  The apparent differences in risk factors for intra- and extracranial atherosclerosis are unclear and the mechanisms that underlie strokes in patients with intracranial atherosclerosis are not well known. We investigated the conventional vascular risk factors as well as other factors in stroke patients with large artery atherosclerosis.
  
  
  METHODS
  Using diffusion weighted imaging (DWI) and vascular and cardiologic studies, we selected patients with acute non-cardioembolic cerebral infarcts within the middle cerebral artery (MCA) territory. Patients were divided into two groups: those with atherosclerotic lesions on the carotid sinus (n = 112) and those with isolated lesions on the proximal MCA (n = 160). Clinical features, risk factors, and DWI patterns were compared between groups.
  
  
  RESULTS
  There were no differences in conventional risk factors, but markers for inflammation were significantly higher in patients with carotid atherosclerosis than in those with isolated MCA atherosclerosis (p < 0.01 for both). After adjustments for age/sex and the severity of stroke, an inverse correlation was observed between C-reactive protein levels and MCA atherosclerosis (odds ratio 0.57 per 1 mg/dl increase; 95% confidence interval 0.35 to 0.92; p = 0.02). Internal borderzone infarcts suggestive of haemodynamic causes were the most frequent DWI pattern in patients with MCA occlusion, whereas territorial infarcts suggesting plaque ruptures were most common in those with carotid occlusion.
  
  
  CONCLUSIONS
  Our results indicate that inflammatory markers, rather than conventional risk factors, reveal clinical and radiological differences between patients with carotid and MCA atherosclerosis. Plaques associated with MCA atherosclerosis may be more stable than those associated with carotid atherosclerosis.
authors: Department of Neurology, College of Medicine, Ajou University, Woncheon-dong San 5, Suwon, Kyungki-do, 442-749, Republic of Korea. nmboy@unitel.co.kr
authors: O Y
authors: OY
authors: Bang
authors: P H
authors: PH
authors: Lee
authors: S R
authors: SR
authors: Yoon
authors: M A
authors: MA
authors: Lee
authors: I S
authors: IS
authors: Joo
authors: K
authors: K
authors: Huh
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D002340:Carotid Artery Diseases / Q000453:epidemiology / Q000378:metabolism* / Q000473:pathology*; D016001:Confidence Intervals; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D006439:Hemodynamics / Q000502:physiology; D006760:Hospitalization; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000453:epidemiology / Q000378:metabolism* / Q000473:pathology; D002537:Intracranial Arteriosclerosis / Q000453:epidemiology / Q000378:metabolism* / Q000473:pathology*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology*; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D005340:Fibrinogen; D002097:C-Reactive Protein