title: Large-vessel stenosis in the patients with ischemic stroke in Iran: Prevalence, pattern, and risk factors.
abstract: BACKGROUND
  Large artery disease (LAD) is a common cause of stroke, but a little is known regarding its role in Iranian stroke patients. The current study investigates the prevalence and risk factors for cervicocephalic arterial stenosis in the patients with ischemic stroke using digital subtraction angiography (DSA).
  
  
  METHODS
  This was a prospective cross-sectional study performed in hospitals affiliated to Shiraz University of Medical Sciences from March 2011 to March 2013. Patients with ischemic stroke underwent noninvasive vascular and cardiac investigations to find the etiology of the stroke. Patients suspected of having large artery stenosis underwent DSA. The severity of the stenosis was calculated according to the North American Symptomatic Carotid Endarterectomy (NASCET) and Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Trial criteria. The presence of cigarette smoking, hyperlipidemia, hypertension, and diabetes mellitus were documented for all subjects.
  
  
  RESULTS
  A total of 3703 stroke patients were identified. Of them, 342 patients (62.3%, male) underwent DSA for LAD. The mean age at the time of angiography was 66.7±10.3 years. Extracranial and intracranial arteries were involved in 305 (89.2%) and 162 (47.4%), respectively. And 301 patients (88%) had anterior circulation and 128 patients (37.4%) had posterior circulation involvement. Diabetes mellitus but not age, sex, hypertension, hyperlipidemia, or smoking was significantly associated with intracranial involvement. (P = 0.002).
  
  
  CONCLUSIONS
  It can be concluded that the distribution of the large arterial atherosclerotic disease in Iran is similar to that seen in North America and Europe. Intracranial stenosis was more prevalent in diabetic patients.
authors.affiliation: Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran ; Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Afshin
authors.initials: A
authors.lastname: Borhani-Haghighi
authors.affiliation: Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Emami
authors.affiliation: Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Amin Sadeghi
authors.initials: AS
authors.lastname: Vasaksi
authors.affiliation: Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Abdolhamid
authors.initials: A
authors.lastname: Shariat
authors.affiliation: Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Mohammad Amin
authors.initials: MA
authors.lastname: Banihashemi
authors.affiliation: Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Nikseresht
authors.affiliation: Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Nahid
authors.initials: N
authors.lastname: Ashjazadeh
authors.affiliation: Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Sadegh
authors.initials: S
authors.lastname: Izadi
authors.affiliation: Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Peyman
authors.initials: P
authors.lastname: Petramfar
authors.affiliation: Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Poursadegh
authors.affiliation: Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Abbas Rahimi
authors.initials: AR
authors.lastname: Jaberi
authors.affiliation: Department of Neurology, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
authors.forename: Sajjad
authors.initials: S
authors.lastname: Emami
authors.affiliation: Neurologist, Shahidzadeh Hospital, Behbahan, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Agheli
authors.affiliation: Department of Neurology, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Nemati
authors.affiliation: Department of Neurology, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Yaghoubi
authors.affiliation: Neurologist, Motaharri Hospital, Marvdasht, Iran.
authors.forename: Mohammad Hosein
authors.initials: MH
authors.lastname: Abdi
authors.affiliation: Neurologist, NIOC Hospital, Gachsaran, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Mohammadi
authors.affiliation: Departments of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Peyman
authors.initials: P
authors.lastname: Jafari
authors.affiliation: Departments of Neurology, Texas Tech University, El Paso, USA.
authors.forename: Salvador
authors.initials: S
authors.lastname: Cruz-Flores
authors.affiliation: Departments of Neurology and Psychiatry , Saint Louis University, Saint Louis, USA.
authors.forename: Randal
authors.initials: R
authors.lastname: Edgell
keywords: Cerebral Angiography; Extracranial; Intracranial; Ischemic; Occlusion; Stenosis; Stroke
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