J Clin Neurol.  2019 Jan;15(1):38-45. 10.3988/jcn.2019.15.1.38.

Intracranial Arterial Calcificationes Can Reflect Cerebral Atherosclerosis Burden

• Kim JM
• Park KY
• Bae JH
• Han SH
• Jeong HB
• Jeong D

• KMID: 2451143
• DOI: http://doi.org/10.3988/jcn.2019.15.1.38

Abstract

BACKGROUND AND PURPOSE
We investigated whether the intracranial arterial calcification status reflects the overall cerebral atherosclerosis burden.
METHODS
Patients with acute cerebral infarction who were admitted to a single university hospital stroke center and underwent brain computed tomography angiography (CTA) between May 2011 and December 2015 were included. We reviewed their demographic, clinical, and imaging data. Cerebral artery calcification was assessed from the cavernous portion of both internal carotid arteries, and patients were categorized into three groups according to the calcification status. The cerebral atherosclerosis score was calculated as the sum of the degree of stenosis of the major intracranial and extracranial arteries on brain CTA.
RESULTS
In total, 1,161 patients were included (age=67±13 years, mean±standard deviation), of which 517 were female. Intracranial arterial calcification and atherosclerosis were detected in 921 patients. The cerebral atherosclerosis score tended to increase with the calcification status (no calcification=2.0±3.0, mild=3.8±3.8, severe=6.5±4.8; p < 0.001 in analysis of variance followed by the Bonferroni test). Multivariable logistic regression analysis including age, sex, vascular risk factors, body mass index, estimated glomerular filtration rate, high-sensitivity C-reactive protein, and calcification status showed that intracranial calcification was independently associated with an advanced cerebral atherosclerosis burden in a dose-dependent manner (compared to no calcification: odds ratio=2.0 and 95% confidence interval=1.1-3.4 for mild calcification, and odds ratio=4.7 and 95% confidence interval=2.7-8.3 for severe calcification).
CONCLUSIONS
This study found that the calcification status of the cavernous portion of an internal carotid artery can reflect the overall cerebral atherosclerosis burden.

Keyword

atherosclerosis; vascular calcification; cerebral infarction

MeSH Terms

Angiography
Arteries
Atherosclerosis
Body Mass Index
Brain
C-Reactive Protein
Carotid Artery, Internal
Cerebral Arteries
Cerebral Infarction
Constriction, Pathologic
Female
Glomerular Filtration Rate
Humans
Intracranial Arteriosclerosis*
Logistic Models
Risk Factors
Stroke
Vascular Calcification
C-Reactive Protein

Figure

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  Fig. 1 Representative imaging results for cerebral arterial calcification and atherosclerosis. A: Patient A without calcification at the cavernous portion of the distal ICA had no discernible atherosclerotic burden. B: Patient B with mild calcification (arrowhead) had atherosclerotic narrowing involving both proximal ICAs (arrows). C: Patient C with severe intracranial arterial calcification (arrowhead) had an advanced atherosclerotic burden with occlusion of the right middle cerebral artery and left proximal ICA, and moderate stenosis of the right ICA (arrows). ICA: internal carotid artery.

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  Fig. 2 Distribution of the cerebral atherosclerosis burden according to calcification status. The percentage of patients with advanced cerebral atherosclerosis tended to increase with the cerebral arterial calcification status (no calcification, 8%; mild, 19%; severe, 43%; p<0.001 in a linear association test). Patients in the advanced cerebral atherosclerosis group were in the highest quartile range of cerebral atherosclerosis scores (>6) in brain computed tomography angiography.

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