title: Study protocol: asymptomatic intracranial atherosclerotic disease in pakistanis.
abstract: BACKGROUND
  Intracranial atherosclerotic disease (ICAD) is the most frequent subtype of ischemic stroke globally. It is important to describe the determinants of early ICAD as a strategy to prevent strokes from clinically evident and progressive ICAD. Our objective is to report the determinants of asymptomatic ICAD by linking the presence or absence of ICAD on magnetic resonance angiogram (MRA) with detailed risk assessment in asymptomatic adults.
  
  
  METHODS
  This is an observational cross-sectional analytical study. We plan to recruit 200 adult participants from the radiology departments of two tertiary care centers of Karachi, Pakistan. The participants will first be screened for the absence of stroke symptoms via the Questionnaire for Verifying Stroke Free Status (QVSFS). QVSFS negative will be participants will be eligible. After written informed consent, participants will undergo detailed medical, sociodemographic, lifestyle, and anthropometric evaluation by a detailed interview. They will, in addition, undergo MRA to study the presence, degree, and distribution of asymptomatic ICAD. All MRA scans will be reviewed centrally by vascular neurologists blinded to clinical information. These images would be reviewed on DICOM Viewer 3.0 used for calculating the degree of stenosis using Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) study defined criteria employing electronic calipers. A sample size of 200 will achieve 80% power for detecting a minimum difference of 20% in the prevalence of exposure factors (medical and lifestyle) between asymptomatic ICAD positive and ICAD negative persons. This study will generate regional data on risks for ICAD development and prevention in a high-risk susceptible population. Study ID: NCT02072876.
authors.affiliation: Associate Professor Neurology, Stroke Service, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan ; Joint First Authors ; Corresponding Author.
authors.forename: Ayeesha Kamran
authors.initials: AK
authors.lastname: Kamal
authors.affiliation: Fogarty Cerebrovascular Research Fellow, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan ; Joint First Authors.
authors.forename: Farzin
authors.initials: F
authors.lastname: Majeed
authors.affiliation: Associate Professor, Director Masters in Epidemiology and Biostatistics Program, Community Health Sciences, Aga Khan University Karachi, Pakistan.
authors.forename: Omrana
authors.initials: O
authors.lastname: Pasha
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Islam
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
authors.forename: Iqbal
authors.initials: I
authors.lastname: Azam
authors.affiliation: Professor of Neurology, Dow University of Health Sciences, Karachi, Pakistan.
authors.forename: Muhammad Saleem
authors.initials: MS
authors.lastname: Ilyas
authors.affiliation: Associate Professor and Head, Dow Institute of Radiology, Dow University of Health Sciences, Karachi, Pakistan.
authors.forename: Munawar
authors.initials: M
authors.lastname: Hussain
authors.affiliation: Radiology Resident, Dow Institute of Radiology, Dow University of Health Sciences, Karachi, Pakistan.
authors.forename: Kamran
authors.initials: K
authors.lastname: Masood
authors.affiliation: Epidemiology and Biostatistics, Dept. of Medicine, Aga Khan University, Karachi, Pakistan.
authors.forename: Bilal
authors.initials: B
authors.lastname: Ahmed
authors.affiliation: Research Associate, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
authors.forename: Sumaira
authors.initials: S
authors.lastname: Nazir
authors.affiliation: Associate Professor and Head, Radiology, Aga Khan University, Karachi, Pakistan.
authors.forename: Zafar
authors.initials: Z
authors.lastname: Sajjad
authors.affiliation: Professor of Neurology, Chief of the Division of Stroke and Neurointensive Care, and Director of the Comprehensive Stroke Center University of Pennsylvania, USA.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Kasner
keywords: Asymptomatic Intracranial Stenosis; Developing Countries; Epidemiology; Prevention; Radiology; Sociodemographic Risk Factors; Stroke
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