Ischemic stroke caused by large-artery atherosclerosis: a red flag for subclinical coronary artery disease

Ana Luíza Vieira de Araújo; Raul D Santos; Marcio Sommer Bittencourt; Roberto Nery Dantas Jr; Carlos André Oshiro; Cesar Higa Nomura; Edson Bor-Seng-Shu; Marcelo de Lima Oliveira; Claudia da Costa Leite; Maria da Graça Morais Martin; Maramelia Miranda Alves; Gisele Sampaio Silva; Victor Marinho Silva; Adriana Bastos Conforto

doi:10.3389/fneur.2023.1082275

Ischemic stroke caused by large-artery atherosclerosis: a red flag for subclinical coronary artery disease

Front Neurol. 2023 Apr 12:14:1082275. doi: 10.3389/fneur.2023.1082275. eCollection 2023.

Authors

Ana Luíza Vieira de Araújo¹, Raul D Santos^{2

3}, Marcio Sommer Bittencourt⁴, Roberto Nery Dantas Jr^{2

3}, Carlos André Oshiro¹, Cesar Higa Nomura^{2

3}, Edson Bor-Seng-Shu¹, Marcelo de Lima Oliveira¹, Claudia da Costa Leite⁵, Maria da Graça Morais Martin⁵, Maramelia Miranda Alves⁶, Gisele Sampaio Silva⁶, Victor Marinho Silva¹, Adriana Bastos Conforto¹

Affiliations

¹ Hospital das Clinicas, Neurology Clinical Division, University of São Paulo, São Paulo, Brazil.
² Heart Institute (Instituto do Coração), University of São Paulo, Medical School Hospital, São Paulo, Brazil.
³ Hospital Israelita Albert Einstein, Academic Research Organization, São Paulo, Brazil.
⁴ Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
⁵ Department of Radiology and Oncology, University of São Paulo, São Paulo, Brazil.
⁶ Neurology and Neurosurgery Department, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.

Abstract

Background: The coronary calcium score (CAC) measured on chest computerized tomography is a risk marker of cardiac events and mortality. We compared CAC scores in two multiethnic groups without symptomatic coronary artery disease: subjects in the chronic phase after stroke or transient ischemic attack and at least one symptomatic stenosis ≥50% in the carotid or vertebrobasilar territories (Group_athero) and a control group (Group_control).

Methods: In this cross-sectional study, Group_athero included two subgroups: Group_ExtraorIntra, with stenoses in either cervical or intracranial arteries, and Group_Extra&Intra, with stenoses in at least one cervical and one intracranial artery. Group_control had no history of prior stroke/transient ischemic attacks and no stenoses ≥50% in cervical or intracranial arteries. Age and sex were comparable in all groups. Frequencies of CAC ≥100 and CAC > 0 were compared between Group_athero and Group_control, as well as between Group_ExtraorIntr, Group_Extra&Intra, and Group_control, with bivariate logistic regressions. Multivariate analyses were also performed.

Results: A total of 120 patients were included: 80 in Group_athero and 40 in Group_control. CAC >0 was significantly more frequent in Group_athero (85%) than Group_control (OR, 4.19; 1.74-10.07; p = 0.001). Rates of CAC ≥100 were not significantly different between Group_athero and Group_control but were significantly greater in Group_Extra&Intra (n = 13) when compared to Group_control (OR 4.67; 1.21-18.04; p = 0.025). In multivariate-adjusted analyses, "Group_athero" and "Group_Extra&Intra" were significantly associated with CAC.

Conclusion: The frequency of coronary calcification was higher in subjects with stroke caused by large-artery atherosclerosis than in controls.

Keywords: cervicocephalic atherosclerosis; coronary atherosclerosis; coronary calcium score; ischemic stroke; subclinical coronary artery disease.

Grants and funding

This research was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP, grant no. 2014/03950-2). RS is a recipient of a scholarship from the Conselho Nacional de Pesquisa e Desenvolvimento Tecnologico (CNPq) grant no. 303734/2018-3. AC is a recipient of a scholarship from the Conselho Nacional de Pesquisa e Desenvolvimento Tecnologico (CNPq) grant no. 303070/2019-6. MB is a recipient of a scholarship from the Conselho Nacional de Pesquisa e Desenvolvimento Tecnologico (CNPq) grant no. 310255/2018-0.