The Karachi intracranial stenosis study (KISS) Protocol: an urban multicenter case-control investigation reporting the clinical, radiologic and biochemical associations of intracranial stenosis in Pakistan.
BACKGROUND
Intracranial stenosis is the most common cause of stroke among Asians. It has a poor prognosis with a high rate of recurrence. No effective medical or surgical treatment modality has been developed for the treatment of stroke due to intracranial stenosis. We aim to identify risk factors and biomarkers for intracranial stenosis and to develop techniques such as use of transcranial doppler to help diagnose intracranial stenosis in a cost-effective manner.


METHODS
The Karachi Intracranial Stenosis Study (KISS) is a prospective, observational, case-control study to describe the clinical features and determine the risk factors of patients with stroke due to intracranial stenosis and compare them to those with stroke due to other etiologies as well as to unaffected individuals. We plan to recruit 200 patients with stroke due to intracranial stenosis and two control groups each of 150 matched individuals. The first set of controls will include patients with ischemic stroke that is due to other atherosclerotic mechanisms specifically lacunar and cardioembolic strokes. The second group will consist of stroke free individuals. Standardized interviews will be conducted to determine demographic, medical, social, and behavioral variables along with baseline medications. Mandatory procedures for inclusion in the study are clinical confirmation of stroke by a healthcare professional within 72 hours of onset, 12 lead electrocardiogram, and neuroimaging. In addition, lipid profile, serum glucose, creatinine and HbA1C will be measured in all participants. Ancillary tests will include carotid ultrasound, transcranial doppler and magnetic resonance or computed tomography angiogram to rule out concurrent carotid disease. Echocardiogram and other additional investigations will be performed at these centers at the discretion of the regional physicians.


CONCLUSIONS
The results of this study will help inform locally relevant clinical guidelines and effective public health and individual interventions.
Kamal
Ayeesha Kamran
AK
Stroke Service, Division of Neurology, Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi-74800, Pakistan. ayeesha.kamal@aku.edu
Taj
Fawad
F
Junaidi
Babar
B
Rasheed
Asif
A
Zaidi
Moazzam
M
Murtaza
Muhammed
M
Iqbal
Naved
N
Hashmat
Fahad
F
Alam
Syed Vaqas
SV
Saleem
Uzma
U
Waheed
Shahan
S
Bansari
Lajpat
L
Shah
Nabi
N
Samuel
Maria
M
Yameen
Madiha
M
Naz
Sobia
S
Khan
Farrukh Shahab
FS
Ahmed
Naveeduddin
N
Mahmood
Khalid
K
Sheikh
Niaz
N
Makki
Karim Ullah
KU
Ahmed
Muhammad Masroor
MM
Memon
Abdul Rauf
AR
Wasay
Mohammad
M
Syed
Nadir Ali
NA
Khealani
Bhojo
B
Frossard
Philippe M
PM
Saleheen
Danish
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002536:Cerebral Arteries / Q000473:pathology*; D002540:Cerebral Cortex / Q000098:blood supply / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D002985:Clinical Protocols; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology