TY - JOUR
T1 - Risk factors and stroke mechanisms in atherosclerotic stroke
T2 - Intracranial compared with extracranial and anterior compared with posterior circulation disease
AU - Kim, Jong S.
AU - Nah, Hyun Wook
AU - Park, Sea Mi
AU - Kim, Su Kyung
AU - Cho, Ki Hyun
AU - Lee, Jun
AU - Lee, Yong Seok
AU - Kim, Jei
AU - Ha, Sang Won
AU - Kim, Eung Gyu
AU - Kim, Dong Eog
AU - Kang, Dong Wha
AU - Kwon, Sun U.
AU - Yu, Kyung Ho
AU - Lee, Byung Chul
PY - 2012/12
Y1 - 2012/12
N2 - Background and Purpose: The aim of this study was to investigate differences in risk factors and stroke mechanisms between intracranial atherosclerosis (ICAS) and extracranial atherosclerosis (ECAS) and between anterior and posterior circulation atherosclerosis. Methods: A multicenter, prospective, Web-based registry was performed on atherosclerotic strokes using diffusion-weighted magnetic resonance imaging and magnetic resonance angiography. Stroke mechanisms were categorized as artery-to-artery embolism, in situ thrombo-occlusion, local branch occlusion, or hemodynamic impairment. Results: One-thousand patients were enrolled from 9 university hospitals. Age (odds ratio [OR], 1.033; 95% confidence interval [CI], 1.018-1.049), male gender (OR, 3.399; 95% CI, 2.335-4.949), and hyperlipidemia (OR, 1.502; 95% CI, 1.117-2.018) were factors favoring ECAS (vs ICAS), whereas hypertension (OR, 1.826; 95% CI, 1.274-2.618; P=0.001) and diabetes mellitus (OR, 1.490; 95% CI, 1.105-2.010; P=0.009) were related to posterior (vs anterior) circulation diseases. Metabolic syndrome was a factor related to ICAS (vs ECAS) only in posterior circulation strokes (OR, 2.433; 95% CI, 1.005-5.890; P=0.007). Stroke mechanisms included artery-to-artery embolism (59.7%), local branch occlusion (14.9%), in situ thrombo-occlusion (13.7%), hemodynamic impairment (0.9%), and mixed (10.8%). Anterior ICAS was more often associated with artery-to-artery embolism (51.8% vs 34.0%) and less often associated with local branch occlusion (12.3% vs 40.4%) than posterior ICAS (P<0.001). Conclusions: The prevalence of risk factors and stroke mechanisms differ between ICAS and ECAS, and between anterior and posterior circulation atherosclerosis. Posterior ICAS seems to be closely associated with metabolic derangement and local branch occlusion. Prevention and management strategies may have to consider these differences.
AB - Background and Purpose: The aim of this study was to investigate differences in risk factors and stroke mechanisms between intracranial atherosclerosis (ICAS) and extracranial atherosclerosis (ECAS) and between anterior and posterior circulation atherosclerosis. Methods: A multicenter, prospective, Web-based registry was performed on atherosclerotic strokes using diffusion-weighted magnetic resonance imaging and magnetic resonance angiography. Stroke mechanisms were categorized as artery-to-artery embolism, in situ thrombo-occlusion, local branch occlusion, or hemodynamic impairment. Results: One-thousand patients were enrolled from 9 university hospitals. Age (odds ratio [OR], 1.033; 95% confidence interval [CI], 1.018-1.049), male gender (OR, 3.399; 95% CI, 2.335-4.949), and hyperlipidemia (OR, 1.502; 95% CI, 1.117-2.018) were factors favoring ECAS (vs ICAS), whereas hypertension (OR, 1.826; 95% CI, 1.274-2.618; P=0.001) and diabetes mellitus (OR, 1.490; 95% CI, 1.105-2.010; P=0.009) were related to posterior (vs anterior) circulation diseases. Metabolic syndrome was a factor related to ICAS (vs ECAS) only in posterior circulation strokes (OR, 2.433; 95% CI, 1.005-5.890; P=0.007). Stroke mechanisms included artery-to-artery embolism (59.7%), local branch occlusion (14.9%), in situ thrombo-occlusion (13.7%), hemodynamic impairment (0.9%), and mixed (10.8%). Anterior ICAS was more often associated with artery-to-artery embolism (51.8% vs 34.0%) and less often associated with local branch occlusion (12.3% vs 40.4%) than posterior ICAS (P<0.001). Conclusions: The prevalence of risk factors and stroke mechanisms differ between ICAS and ECAS, and between anterior and posterior circulation atherosclerosis. Posterior ICAS seems to be closely associated with metabolic derangement and local branch occlusion. Prevention and management strategies may have to consider these differences.
KW - Angiogram
KW - Cerebrovascular disease
KW - Diagnosis
KW - Registry
UR - http://www.scopus.com/inward/record.url?scp=84870866119&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.112.658500
DO - 10.1161/STROKEAHA.112.658500
M3 - Article
C2 - 23160885
AN - SCOPUS:84870866119
SN - 0039-2499
VL - 43
SP - 3313
EP - 3318
JO - Stroke
JF - Stroke
IS - 12
ER -
