Risk factors and clinical outcomes associated with intracranial and extracranial atherosclerotic stenosis acute ischemic stroke

J Stroke Cerebrovasc Dis. 2014 May-Jun;23(5):1112-7. doi: 10.1016/j.jstrokecerebrovasdis.2013.09.024. Epub 2013 Nov 1.

Abstract

Background: The aim of this study was to investigate differences in risk factors, lipid profiles, mortality, and poor functional outcome in the long term in patients who had stroke associated with intracranial and/or extracranial atherosclerotic stenosis.

Methods: We consecutively and prospectively enrolled patients admitted to our hospital with acute ischemic stroke. Included patients were classified into 4 groups based on stroke subtype: noncerebral artery stenosis (NCAS), intracranial stenosis (IS), extracranial stenosis (ES), and combined intracranial and extracranial stenosis (IES). Risk factors, lipid profiles, mortality, and poor functional outcome in the long term were compared among the stenosis subtypes.

Results: In total, 1196 patients were included in the analysis. Independent IS markers were found to be diabetes mellitus (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.08-1.80, P = .01) and low-density lipoprotein (LDL) of 2.6 mmol/L or more at admission (OR 3.48, 95% CI 2.69-4.50, P < .01). Factors that increased risk for ES and IES were male gender (ES, OR 2.26, 95% CI 1.29-3.98, P < .01; IES, OR 1.65, 95% CI 1.08-2.53, P = .02), older age (ES, OR 1.03, 95% CI 1.01-1.05, P = .02; IES, OR 1.03, 95% CI 1.01-1.04, P < .01), and LDL of 2.6 mmol/L or more (ES, OR 1.74, 95% CI 1.05-2.88, P = .03; IES, OR 2.08, 95% CI 1.36-3.18, P < .01). Poor functional outcome and mortality were significantly more frequent in the IS and IES groups than in the NCAS group at 3 months and 1 year after discharge.

Conclusions: Patients with IS and IES were at higher risk of poor functional outcome and mortality than were patients with NCAS. Risk factors and lipid profiles differed among the stenosis subtypes. Thus, targeted strategies may need to take these differences into account to prevent or manage poor functional outcomes and mortality.

Keywords: Atherosclerosis; lipid profiles; mortality; poor functional outcome; risk factors.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Biomarkers / blood
  • Brain Ischemia / blood
  • Brain Ischemia / diagnosis
  • Brain Ischemia / etiology*
  • Brain Ischemia / mortality
  • Brain Ischemia / physiopathology
  • Brain Ischemia / therapy
  • Carotid Stenosis / blood
  • Carotid Stenosis / complications*
  • Carotid Stenosis / diagnosis
  • Carotid Stenosis / mortality
  • Carotid Stenosis / physiopathology
  • Carotid Stenosis / therapy
  • Chi-Square Distribution
  • China
  • Cross-Sectional Studies
  • Female
  • Humans
  • Intracranial Arteriosclerosis / blood
  • Intracranial Arteriosclerosis / complications*
  • Intracranial Arteriosclerosis / diagnosis
  • Intracranial Arteriosclerosis / mortality
  • Intracranial Arteriosclerosis / physiopathology
  • Intracranial Arteriosclerosis / therapy
  • Lipids / blood
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Prospective Studies
  • Recovery of Function
  • Registries
  • Risk Factors
  • Stroke / blood
  • Stroke / diagnosis
  • Stroke / etiology*
  • Stroke / mortality
  • Stroke / physiopathology
  • Stroke / therapy
  • Time Factors
  • Treatment Outcome

Substances

  • Biomarkers
  • Lipids