title: Carotid siphon calcification impact on revascularization and outcome in stroke intervention.
abstract: OBJECTIVE
  The degree of coronary artery calcification has been shown to predict outcomes in coronary artery disease. The impact of intracranial carotid artery calcification on the prognosis of acute ischemic stroke (AIS) is unknown. The authors sought to examine if the degree of intracranial carotid artery calcification influences reperfusion or outcomes in AIS intervention.
  
  
  METHODS
  All anterior circulation large vessel occlusion AIS cases that underwent intra-arterial therapy from January 2009 to July 2012 were reviewed. Clinical and radiographic data were collected. Non-contrast brain CT scans were assigned a Calcium Extent Score (degree of calcification of the carotid wall circumference), Calcium Thickness Score (thickness of the calcified plaque), and total Carotid Siphon Calcium (CSC) Score (8-point scale).
  
  
  RESULTS
  One-hundred seventeen patients met inclusion criteria. The mean age was 65.4±15.6 years and 36% were male. Calcification was present in the intracranial carotid artery of 84 patients (71%). Inter-rater agreement for total CSC score was strong (Spearman's rho=0.883, p<0.001). The mean Calcium Extent Score was 1.5±1.3, Calcium Thickness Score 1.3±1.0 and total CSC Score 2.8±2.2. Reperfusion and mRS were not associated with CSC. Multivariate linear regression analysis revealed that older age, history of coronary disease and cervical internal carotid occlusion/near-occlusion were independently associated with higher total CSC scores.
  
  
  CONCLUSIONS
  Extensive calcification on the intracranial carotid artery does not have impact on reperfusion or clinical outcomes in AIS patients undergoing endovascular therapy. Higher CSC scores are associated with coronary artery disease, increasing age and cervical internal carotid artery occlusion/near-occlusion.
authors.affiliation: Departments of Neurology and Neurosurgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA.
authors.forename: Diogo C
authors.initials: DC
authors.lastname: Haussen
authors.affiliation: Departments of Neurology and Neurosurgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA.
authors.forename: Brandon G
authors.initials: BG
authors.lastname: Gaynor
authors.affiliation: Departments of Neurology and Neurosurgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA.
authors.forename: Jeremiah N
authors.initials: JN
authors.lastname: Johnson
authors.affiliation: Departments of Neurology and Neurosurgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Peterson
authors.affiliation: Departments of Neurology and Neurosurgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA.
authors.forename: Mohamed Samy
authors.initials: MS
authors.lastname: Elhammady
authors.affiliation: Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, USA.
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Aziz-Sultan
authors.affiliation: Departments of Neurology and Neurosurgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA. Electronic address: dyavagal@med.miami.edu.
authors.forename: Dileep R
authors.initials: DR
authors.lastname: Yavagal
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000188:drug therapy; D002114:Calcinosis / Q000000981:diagnostic imaging*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
keywords: Atherosclerosis; Endovascular procedures; Internal carotid artery diseases; Stroke; Vascular calcification