title: Italian symptomatic intracranial atherosclerosis study (ISIDE) : A multicenter transcranial ultrasound evaluation.
abstract: There are currently no data available on the prevalence of symptomatic intracranial atherosclerosis (ICAS) in Italy. The aim of this prospective, multicenter, hospital-based, transcranial ultrasound study was to establish the prevalence of ICAS among patients hospitalized with acute ischemic stroke. At 11 stroke centers across Italy, patients consecutively admitted for their first ever acute ischemic stroke were assessed prospectively over a 24-month period either with transcranial color-coded Doppler sonography (TCCS) or transcranial Doppler (TCD) according to validated criteria. ICAS was diagnosed when there was an evidence of a cerebral infarction in the territory of a ≥50 % stenosis detected by TCCS/TCD and confirmed by magnetic resonance angiography or computed tomography angiography. A total of 1134 patients were enrolled, 665 of them (58.6 %) men, with a mean age of 71.2 ± 13.3 years. ICAS was recorded in 99 patients (8.7 % of the whole sample, 8.9 % among Caucasians), most commonly located in the anterior circulation (63 of 99, 5.5 %). After adjusting for potential confounders, multivariate analysis identified carotid/vertebral ≥50 % stenosis [odds ratio (OR) 2.59, 95 % (confidence interval) CI 1.77-6.33; P = 0.02] and hypercholesterolemia (OR 1.38, 95 % CI 1.02-1.89; P = 0.02) as being independently associated with ICAS. ICAS is a surprisingly relevant cause of ischemic stroke in Italy, identified in almost 9 % of first-ever stroke patients. It is more prevalent in the anterior circulation and independently associated with hemodynamically significant cervical vessel atherosclerosis and hypercholesterolemia. These findings support the systematic use of transcranial ultrasound to identify ICAS in patients presenting with acute ischemic stroke and in cases with ≥50 % cervical vessel stenoses.
authors.affiliation: Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Via Giustiniani 5, 35128, Padua, Italy. claudiobaracchini@gmail.com.
authors.forename: Claudio
authors.initials: C
authors.lastname: Baracchini
authors.affiliation: Neurologic Clinic and Rehabilitation Department, Casa di Cura Villa Barbarano, Salò, Italy.
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Anzola
authors.affiliation: UO Neurologia, USL Umbria 1, Ospedale di Città di Castello (PG), Città di Castello, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Cenciarelli
authors.affiliation: UOC Stroke Unit, Dipartimento di Neuroscienze, Fondazione Policlinico Tor Vergata, Rome, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Diomedi
authors.affiliation: UOS Malattie Cerebrovascolari Acute, University of Catania, Catania, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Bella
authors.affiliation: Divisione di Neurologia, Ospedale SS. Giovanni e Paolo, Venice, Italy.
authors.forename: Agnese
authors.initials: A
authors.lastname: Tonon
authors.affiliation: Stroke Unit, Azienda Ospedaliera di Desio e Vimercate, Vimercate, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Braga
authors.affiliation: Stroke Unit, Department of Neuromotor Physiology, Arcispedale Santa Maria Nuova IRCCS Reggio Emilia, Reggio Emilia, Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Zedde
authors.affiliation: Neurosonology Service, Department of Neuroscience, University of Parma, Parma, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Zanferrari
authors.affiliation: Divisione di Neurologia, Ospedale Galliera, Genoa, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Del Sette
authors.affiliation: Department of Geriatrics, Neuroscience, Orthopedics and Physiatrics, Institute of Neurology, Catholic University, Rome, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Caliandro
authors.affiliation: Stroke Unit, University of Genoa, DINOGMI, Genoa, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Gandolfo
authors.affiliation: UO Neurologia, USL Umbria 1, Ospedale di Città di Castello (PG), Città di Castello, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ricci
authors.affiliation: Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Via Giustiniani 5, 35128, Padua, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Meneghetti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*
keywords: ICAS; Stroke; Symptomatic intracranial atherosclerosis; Ultrasound