Türk Beyin Damar Hast Derg. Ahead of Print: TBDHD-76768 | DOI: 10.5505/tbdhd.2024.76768

Relationship of intracranial carotid artery calcification patterns with clinical factors and its effect on clinical outcome in patients with ischemic stroke

Hatice Deniz Hintoðlu¹, Aygül Tantik Pak¹, Büþra Elif Yýldýrým¹, Rümeysa Taþcý Bulca¹, Neslin Þahin², Münevver Çelik Gökyigit^1
1Gaziosmanpasa Training and Research Hospital, Depertmant of Neurology, Ýstanbul, Turkey
²Gaziosmanpasa Training and Research Hospital, Depertmant of Radiology, Ýstanbul, Turkey

INTRODUCTION: Internal intracranial carotid artery(iICA) calcifications are an important risk factor for stroke.The aim of this study is to determine which clinical factors are associated with the medial and intimal calcification patterns of the iICA in patients with ischemic stroke and to determine the effect of these calcification patterns on clinical outcome.
METHODS: Our study was planned as a retrospective observational study.Patients with acute ischemic stroke who were hospitalized in our clinic within the last one year (August 2021-July 2022)were included in the study. Initial computed tomography(CT) and of all patients were evaluated by an experienced radiologist.In our study, patients were divided into three groups according to a recently developed and validated scoring method(a method that evaluates the roundness, structure, and morphology of calcification using a specific weight to determine whether the calcification is predominantly intimal(<7 points) or medial(≥7 points).Those without iICA calcification were included in groupI, those with intimal calcification were included in groupII, and those with medial calcification were included in group III.
RESULTS: Of the114patients, 44.7%(n=51)were female and the mean age of the patients was 63.08±13.94 years. According to the calcification pattern, it was determined as group I: 15.8%(n = 18), group II: 37.7%(n = 43), group III: 46.5%(n = 53).When demographic and clinical variables of the three groups were evaluated, significant differences were found between groupI and groupIII in terms of age(p<0.001), hypertension(p<0.001), diabetes(p<0.001) and hyperlipidemia(p=0.015).In the neurologic evaluation ofthe patients, no significant difference was found between group I and group III with the initial NIHSS scores, but a significant difference was found between the NIHSscores evaluated at the 1st month.
DISCUSSION AND CONCLUSION: The location of iICA calcification in the arterial wall affects the clinical outcome of stroke patients.The iICA calcification prevalance increase with age and can be reduced by treating modifiable risk factors such as hypertension, hyperlipidemia and diabetes.

Keywords: Carotid artery, calcification, medial layer.

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Ýskemik inme geçiren hastalarda intrakraniyal karotis arter kalsifikasyon paternlerinin klinik faktörlerle iliþkisi ve klinik sonlanýma etkisi

Hatice Deniz Hintoðlu¹, Aygül Tantik Pak¹, Büþra Elif Yýldýrým¹, Rümeysa Taþcý Bulca¹, Neslin Þahin², Münevver Çelik Gökyigit^1
1Gaziosmanpaþa Eðitim ve Araþtýrma Hastanesi, Nöroloji Kliniði, Ýstanbul
²Gaziosmanpaþa Eðitim ve Araþtýrma Hastanesi, Radyoloji Kliniði, Ýstanbul

GÝRÝÞ ve AMAÇ: Ýntrakranial internal karotid arter (iICA) kalsifikasyonlarý inme için önemli bir risk faktörüdür. Bu çalýþmanýn amacý, iskemik inme geçiren hastalarda iICA’in medial ve intimal kalsifikasyon paternlerinin hangi klinik faktörlerle iliþkili olduðunu belirlemek ve bu kalsifikasyon paternlerinin klinik sonlanýma etkisini saptamaktýr.
YÖNTEM ve GEREÇLER: Çalýþmamýz retrospektif gözlemsel bir çalýþma olarak planlanmýþtýr. Çalýþmaya son 1 yýl içerisinde (2021 aðustos-2022 temmuz dönemi) kliniðimizde yatarak akut iskemik inme tanýsý almýþ olan hastalar dahil edilmiþtir. Tüm hastalarýn baþlangýçta çekilen bilgisayarlý tomografileri (BT) bu konuda deneyimli radyoloji uzmaný tarafýndan deðerlendirilmiþtir. Çalýþmamýzda hastalar yakýn zamanda geliþtirilen ve valide edilmiþ bir puanlama yöntemine göre (kalsifikasyonun aðýrlýklý olarak intimal (<7 puan) veya medial (≥7 puan) olup olmadýðýný belirlemek için belirli bir aðýrlýk kullanarak kalsifikasyonun daireselliðini, kalýnlýðýný ve morfolojisini deðerlendiren bir yöntem) iICA kalsifikasyonu olmayanlar grup I, intimal kalsifikasyonu olanlar grup II, medial kalsifikasyonu olanlar grup III olarak ayrýlmýþtýr.
BULGULAR: Çalýþmaya katýlan 114 hastanýn %44,7(n=51)’si kadýn olup hastalarýn yaþ ortalamasý 63,08±13,94 olarak saptandý. Kalsifikasyon paternine göre grup I: %15,8 (n=18), grup II: %37,7(n=43), grup III: %46,5(n=53) olarak saptanmýþtýr.Üç grubun demografik ve klinik deðiþkenleri deðerlendirildiðinde grup I ile grup III arasýnda yaþ (p<0.001), hipertansiyon (p<0.001), diyabet (p<0.001) ve hiperlipidemi (p=0.015) açýsýndan anlamlý fark saptanmýþtýr.Hastalarýn nörolojik olarak deðerlendirilmesinde grup I ile grup III arasýnda ilk NIHSS ile anlamlý fark saptanmazken hastalarýn 1. ayda deðerlendirilen NIHSS arasýnda anlamlý derecede fark saptanmýþtýr.
TARTIÞMA ve SONUÇ: iÝCA daki kalsifikasyonun damar duvarýndaki yerleþim yeri inme hastalarýnýn klinik sonlanýmýný etkilemektedir. iÝCA daki kalsifikasyon oranlarý yaþ ile artmakta olup deðiþtirilebilir risk faktörlerinden altta yatan hipertansiyon, hiperlipidemi ve diyabetin tedavisiyle bu oranlar düþürülebilir.

Anahtar Kelimeler: Karotis arter, kalsifikasyon, media tabaka.

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