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Inflammatory markers, rather than conventional risk factors, are different between carotid and MCA atherosclerosis.

Bang, OY; Lee, PH; Yoon, SR; Lee, MA; Joo, IS; Huh, K
Journal of neurology, neurosurgery, and psychiatry, 76(8):1128-1134, 2005
Journal Title
Journal of neurology, neurosurgery, and psychiatry
BACKGROUND: The apparent differences in risk factors for intra- and extracranial atherosclerosis are unclear and the mechanisms that underlie strokes in patients with intracranial atherosclerosis are not well known. We investigated the conventional vascular risk factors as well as other factors in stroke patients with large artery atherosclerosis.

METHODS: Using diffusion weighted imaging (DWI) and vascular and cardiologic studies, we selected patients with acute non-cardioembolic cerebral infarcts within the middle cerebral artery (MCA) territory. Patients were divided into two groups: those with atherosclerotic lesions on the carotid sinus (n = 112) and those with isolated lesions on the proximal MCA (n = 160). Clinical features, risk factors, and DWI patterns were compared between groups.

RESULTS: There were no differences in conventional risk factors, but markers for inflammation were significantly higher in patients with carotid atherosclerosis than in those with isolated MCA atherosclerosis (p < 0.01 for both). After adjustments for age/sex and the severity of stroke, an inverse correlation was observed between C-reactive protein levels and MCA atherosclerosis (odds ratio 0.57 per 1 mg/dl increase; 95% confidence interval 0.35 to 0.92; p = 0.02). Internal borderzone infarcts suggestive of haemodynamic causes were the most frequent DWI pattern in patients with MCA occlusion, whereas territorial infarcts suggesting plaque ruptures were most common in those with carotid occlusion.

CONCLUSIONS: Our results indicate that inflammatory markers, rather than conventional risk factors, reveal clinical and radiological differences between patients with carotid and MCA atherosclerosis. Plaques associated with MCA atherosclerosis may be more stable than those associated with carotid atherosclerosis.
MeSH terms
Acute DiseaseAdultAgedC-Reactive Protein/metabolism*Carotid Artery Diseases/epidemiologyCarotid Artery Diseases/metabolism*Carotid Artery Diseases/pathology*Confidence IntervalsFemaleFibrinogen/metabolism*Hemodynamics/physiologyHospitalizationHumansInfarction, Middle Cerebral Artery/epidemiologyInfarction, Middle Cerebral Artery/metabolism*Infarction, Middle Cerebral Artery/pathologyIntracranial Arteriosclerosis/epidemiologyIntracranial Arteriosclerosis/metabolism*Intracranial Arteriosclerosis/pathology*Magnetic Resonance AngiographyMagnetic Resonance ImagingMaleMiddle AgedMiddle Cerebral Artery/pathology*Prospective StudiesRisk Factors
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Journal Papers > School of Medicine / Graduate School of Medicine > Neurology
AJOU Authors
방, 오영이, 필휴주, 인수허, 균
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