Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China: the Chinese Intracranial Atherosclerosis (CICAS) Study.
OBJECTIVE
We aimed to establish the prevalence, characteristics, and outcomes of intracranial atherosclerosis (ICAS) in China by a large, prospective, multicenter study.


METHODS
We evaluated 2864 consecutive patients who experienced an acute cerebral ischemia<7 days after symptom onset in 22 Chinese hospitals. All patients underwent magnetic resonance angiography, with measurement of diameter of the main intracranial arteries. ICAS was defined as ≥50% diameter reduction on magnetic resonance angiography.


RESULTS
The prevalence of ICAS was 46.6% (1335 patients, including 261 patients with coexisting extracranial carotid stenosis). Patients with ICAS had more severe stroke at admission and stayed longer in hospitals compared with those without intracranial stenosis (median National Institutes of Health Stroke Scale score, 3 versus 5; median length of stay, 14 versus 16 days; both P<0.0001). After 12 months, recurrent stroke occurred in 3.27% of patients with no stenosis, in 3.82% for those with 50% to 69% stenosis, in 5.16% for those with 70% to 99% stenosis, and in 7.27% for those with total occlusion. Cox proportional hazards regression analyses showed that the degree of arterial stenosis, age, family history of stroke, history of cerebral ischemia or heart disease, complete circle of Willis, and National Institutes of Health Stroke Scale score at admission were independent predictors for recurrent stroke at 1 year. The highest rate of recurrence was observed in patients with occlusion with the presence of ≥3 additional risk factors.


CONCLUSIONS
ICAS is the most common vascular lesion in patients with cerebrovascular disease in China. Recurrent stroke rate in our study was lower compared with those of previous clinical trials but remains unacceptably high in a subgroup of patients with severe stenosis.
From Beijing Tiantan Hospital of Capital Medical University, Beijing, China (Yo. Wang, X.Z., L.L., Y. Pu, Y. Pan, Yi. Wang, C.W.); Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR (Y.O.Y.S., X.Z., T.W.H.L., K.S.L.W.); Guangdong Hospital of Traditional Chinese Medicine, Guangzhou, China (Y.C.); Shanghai Pudong New Area People's Hospital, Shanghai, China (Q.B.); Handan First People's Hospital, Shanghai, China (Yi. Wu); Guangzhou City People's First Hospital, Guangzhou, China (X.P.); and The First Affiliated Hospital of Zhejiang University, Zhejiang, China (B.L.).
Yongjun
Y
Wang
Xingquan
X
Zhao
Liping
L
Liu
Yannie O Y
YO
Soo
Yuehua
Y
Pu
Yuesong
Y
Pan
Yilong
Y
Wang
Xinying
X
Zou
Thomas W H
TW
Leung
Yefeng
Y
Cai
Qingke
Q
Bai
Yiping
Y
Wu
Chunxue
C
Wang
Xiaoping
X
Pan
Benyan
B
Luo
Ka Sing Lawrence
KS
Wong
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001157:Arterial Occlusive Diseases / Q000453:epidemiology* / Q000628:therapy*; D002533:Cerebral Angiography; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000628:therapy*; D002681:China / Q000453:epidemiology; D003251:Constriction, Pathologic; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D002537:Intracranial Arteriosclerosis / Q000453:epidemiology* / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012008:Recurrence; D012306:Risk; D012307:Risk Factors
intracranial arteriosclerosis; prevalence; prognosis