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Different Vascular Risk Factors Associated with Cervical and Cerebral Atherosclerotic Steno-occlusions in Patients with Acute Ischemic Stroke

Do-Hyung Kim, Sung-Yeon Sohn, Hanna Choi, Jae Guk Kim and Soo Joo Lee

Background: Besides race-ethnicity, the role of other risk factors that can be related to the distribution of cerebral atherosclerosis has been controversial. We determined if there were vascular factors related to the extra- and intracranial atherosclerosis in ischemic stroke patients.

Methods: We studied 856 consecutive patients with ischemic stroke admitted to our two hospitals over a 5- year period. We excluded patients who had potential cardiogenic source of embolism. The information about potential vascular risk factors, such as age, sex, arterial hypertension, diabetes mellitus, hyperlipidemia, cigarette smoking, and alcohol consumption, was obtained from medical records. We determined the location and severity of atherosclerotic lesions on MR angiography (MRA). The presence of atherosclerotic lesion in intracranial cerebral arteries and extracranial carotid artery was defined as 50% or more narrowing of luminal diameter or occlusion on MRA. We compared the vascular risk factors between patients with extra- and/ or intracranial atherosclerosis and those with no atherosclerotic lesion.

Results: The intracranial atherosclerotic lesion on MRA was found in 355 patients (41.5%). Of the other patients 61 (7.1%) had steno-occlusive extracranial carotid artery disease, and 78 (9.1%) had combined extracranial carotid and intracranial atherosclerotic lesions. Multivariate logistic regression analyses showed that hyperlipidemia was associated with the extracranial carotid atherosclerosis (OR, 4.12; 95% CI, 1.21-9.11; p<0.01), but that diabetes mellitus was only associated with intracranial atherosclerosis (OR, 3.26; 95% CI, 1.45 – 6.52; p<0.01).

Conclusion: Our data suggest that the factors associated with extra- and intracranial artery lesion were different. Diabetes mellitus may be associated with the development of intracranial atherosclerosis, which is predominant in Korean stroke patients.