J Stroke.  2015 Jan;17(1):67-75. 10.5853/jos.2015.17.1.67.

Cerebral Arterial Calcification Is an Imaging Prognostic Marker for Revascularization Treatment of Acute Middle Cerebral Arterial Occlusion

• Lee SJ
• Hong JM
• Lee M
• Huh K
• Choi JW
• Lee JS

• KMID: 2223688
• DOI: http://doi.org/10.5853/jos.2015.17.1.67

Abstract

BACKGROUND AND PURPOSE
To study the significance of intracranial artery calcification as a prognostic marker for acute ischemic stroke patients undergoing revascularization treatment after middle cerebral artery (MCA) trunk occlusion.
METHODS
Patients with acute MCA trunk occlusion, who underwent intravenous and/or intra-arterial revascularization treatment, were enrolled. Intracranial artery calcification scores were calculated by counting calcified intracranial arteries among major seven arteries on computed tomographic angiography. Patients were divided into high (HCB; score > or =3) or low calcification burden (LCB; score <3) groups. Demographic, imaging, and outcome data were compared, and whether HCB is a prognostic factor was evaluated. Grave prognosis was defined as modified Rankin Scale 5-6 for this study.
RESULTS
Of 80 enrolled patients, the HCB group comprised 15 patients, who were older, and more commonly had diabetes than patients in the LCB group. Initial National Institutes of Health Stroke Scale (NIHSS) scores did not differ (HCB 13.3+/-2.7 vs. LCB 14.6+/-3.8) between groups. The final good reperfusion after revascularization treatment (thrombolysis in cerebral infarction score 2b-3, HCB 66.7% vs. LCB 69.2%) was similarly achieved in both groups. However, the HCB group had significantly higher NIHSS scores at discharge (16.0+/-12.3 vs. 7.9+/-8.3), and more frequent grave outcome at 3 months (57.1% vs. 22.0%) than the LCB group. HCB was proven as an independent predictor for grave outcome at 3 months when several confounding factors were adjusted (odds ratio 4.135, 95% confidence interval, 1.045-16.359, P=0.043).
CONCLUSIONS
Intracranial HCB was associated with grave prognosis in patients who have undergone revascularization for acute MCA trunk occlusion.

Keyword

Vascular calcification; Middle cerebral artery infarction; Intracranial embolism; Intracranial thrombosis; Thrombolytic therapy; Risk factors

MeSH Terms

Angiography
Arteries
Cerebral Infarction
Hexachlorobenzene
Humans
Infarction, Middle Cerebral Artery
Intracranial Embolism
Intracranial Thrombosis
Middle Cerebral Artery
National Institutes of Health (U.S.)
Prognosis
Reperfusion
Risk Factors
Stroke
Thrombolytic Therapy
Vascular Calcification
Hexachlorobenzene