title: Prevalence and calcification of intracranial arterial stenotic lesions as assessed with multidetector computed tomography angiography.
abstract: OBJECTIVE
  Intracranial arterial stenosis (ICAS) in patients with recent ischemic stroke is associated with a high risk of recurrent stroke. More insight into the pathophysiology of ICAS could help identify patients at high risk requiring more aggressive secondary prevention. We evaluated the prevalence, distribution, calcification, and the risk factors predisposing ICAS in a European stroke population.
  
  
  METHODS
  Consecutive patients with a transient ischemic attack or ischemic stroke (n=786) were evaluated for the presence and distribution of ICAS (≥30% luminal narrowing) by CT angiography. ICAS were categorized as symptomatic or asymptomatic, and the presence of calcification was assessed. The association of traditional cerebrovascular risk factors and the erythrocyte sedimentation rate with ICAS was analyzed.
  
  
  RESULTS
  In 178 of 786 patients (23%), 288 ICAS were observed. Most stenoses (n=194/288; 67%) were located in the posterior circulation arteries. In 59 of 786 patients (8%), ICAS were considered symptomatic. ICAS in the basilar artery and arteries beyond the circle of Willis were mainly noncalcified. In addition to age, gender, and several traditional cerebrovascular risk factors, erythrocyte sedimentation rate was independently associated with the presence of ICAS (OR, 1.20; 95% CI, 1.06-1.36) and with the presence of noncalcified ICAS in particular (OR, 1.20; 95% CI, 1.05-1.37).
  
  
  CONCLUSIONS
  ICAS was observed in a noteworthy number of European stroke patients. Particularly, the majority of ICAS was observed in the posterior circulation, possibly conferring worse prognosis. ICAS in distal arteries were mainly noncalcified. Association of noncalcified ICAS and erythrocyte sedimentation rate may indicate a prominent role for inflammatory factors in intracranial atherosclerotic disease.
authors: Department of Radiology, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands. p.homburg@erasmusmc.nl
authors: Philip J
authors: PJ
authors: Homburg
authors: Gerben J J
authors: GJ
authors: Plas
authors: Sietske
authors: S
authors: Rozie
authors: Aad
authors: A
authors: van der Lugt
authors: Diederik W J
authors: DW
authors: Dippel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001799:Blood Sedimentation; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000000981:diagnostic imaging*; D003251:Constriction, Pathologic / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D036542:Tomography, Spiral Computed