Intracranial Internal Carotid Artery Wall Calcification in Ischemic Strokes Treated with Thrombolysis

Eur Neurol. 2018;79(1-2):21-26. doi: 10.1159/000477901. Epub 2017 Nov 13.

Abstract

Background: Calcifications are an important element of atherosclerotic plaques and have been used as a marker of atherosclerosis and clinical outcome predictor in different vascular territories. CT-scan, performed in the acute ischemic stroke setting, can reliably detect intracranial arterial calcifications.

Objectives: To investigate the association between intracranial internal carotid artery calcification and functional outcome, symptomatic intracerebral hemorrhage (sICH), recanalization, and death.

Methods: We included 396 consecutive ischemic stroke patients submitted to recombinant tissue plasminogen activator treatment between January 2011 and September 2014. Admission CT-scans were reviewed to calculate the Total Carotid Syphon Calcification score. Patients were followed for up to at least 6 months post-stroke or until death. Outcome measures included evaluation of recanalization on the first 24 h (transcranial color coded Doppler or angio-CT), sICH, and assessment of functional outcome at 3 months after stroke (using modified Rankin scale).

Results: Carotid artery wall calcification did not predict sICH, recanalization or any good outcome. However, it was a statistically significant predictor of death (OR 1.102, 95% CI [1.004-1.211], p = 0.042).

Discussion: Intracranial carotid artery calcification does not increase the risk of thrombolysis-induced sICH. Patients with higher grade of carotid artery wall calcification may have a higher mortality rate.

Keywords: Calcification; Carotid; Hemorrhage; Outcome; Stroke; Thrombolysis.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Calcinosis / mortality
  • Calcinosis / pathology*
  • Carotid Artery Diseases / drug therapy
  • Carotid Artery Diseases / pathology*
  • Carotid Artery, Internal / pathology*
  • Cerebral Hemorrhage / etiology
  • Female
  • Fibrinolytic Agents / adverse effects
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Stroke / drug therapy*
  • Stroke / mortality
  • Thrombolytic Therapy / adverse effects
  • Thrombolytic Therapy / methods*
  • Tissue Plasminogen Activator / adverse effects
  • Tomography, X-Ray Computed
  • Treatment Outcome

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator