Abstract
Background: Intracranial atherosclerotic stenosis (ICAS) is a common cause of ischemic stroke worldwide and probably in India.. The common risk factors for development of intracranial atherosclerosis include hypertension, diabetes, tobacco use and hyperlipidemia. The morbidity and mortality associated with ischemic stroke makes it essential that individuals with risk factors must be identified and appropriate interventions must be done to prevent stroke.
Aim: The aim of this study was to describe the risk factors, distribution of vascular lesions and outcome of stroke due to ICAS.
Methodology: All consecutive patients of ischemic stroke due to ICAS were enrolled prospectively on the basis of a predefined inclusion and exclusion criteria. Demographic details and history of systemic illnesses particularly diabetes and hypertension was noted in all the cases. Vascular territory involved was determined on the basis of imaging (computerized tomography, Magnetic resonance imaging and MR angiography. Details about, risk factors, vascular lesions and outcome were noted. Data was examined using SSPE 16.0 software. For statistical purposes p value less than 0.05 was taken as statistically significant.
Result: Out of 455 patients there were 328 (72.09%) males and 127 (27.91%) females with a M:F ratio of 1:0.38. The most common age group affected in males and females was 61-70 years (M-29.45%, F-11.42%) followed by 51-60 years (25.93%) in males and more than 70 years (9.89%) in females.The difference in mean age of males and females was found to be statistically ‘highly significant’.The most common risk factors associated with stroke was hypertension (54.29%) followed by diabetes mellitus (51.43%).Middle cerebral artery was involved in majority of the cases (n-299, 65.71%). Mean duration of hospital stay was found to be 9.81 +/- 7.17 days. Mortality rate was found to be 11.65%.
Conclusion: Intracranial atherosclerotic stenosis (ICAS) is a common cause of ischemic stroke Identification of risk factors and their management remains the best strategy for preventing recurrence.
Keywords: Intracranial atherosclerosis, Ischemic stroke, Middle cerebral artery, Risk Factors.
References
- López-Cancio E, Matheus MG, Romano JG, et al. Infarct patterns, collaterals and likely causative mechanisms of stroke in symptomatic intracranial atherosclerosis. Cerebrovasc Dis. 2014;37(6):417-22.
- Gorelick PB, Wong KS, Bae HJ, Pandey DK. Large artery intracranal occlusive disease worldwide burden but a relatively neglected frontier. stroke 2008 ; 39 : 2396-9.
- Qureshi AI, Feldmann E, Gomez CR, Johnston sC, Kasner sE, Quick Dc, el ol. Intraeranial atherosclerotic disease: An update. Ann Neuro1 2009;66730-8.
- Birenbaum D, Bancroft LW, Felsberg GJ. Imaging in acute stroke. West J Emerg Med. 2011;12(1):67-76.
- Reyes S P, Badilla O L, Andreu D, Besa V, Rivera R, Sordo G, Bustamante G,Pasten JA, Vargas G, Silva P, Guerrero R, Feuerhake W. [Emergency endovascular management of ischemic stroke. Experience in 104 patients]. Rev Med Chil. 2018 Jun;146(6):708-716.
- Mishra T, Ishwar A, Pandey P, Singh A, Chandrakar MP, Pharmani S. A study of clinical profile and risk factors in Ischemic stroke with special reference to serum homocysteine and lipid profile: a cross sectional observation study. Int J Adv Med 2016;3:888-92.
- Chraa M, Louhab N, Kissani N. Stroke in young adults: about 128 cases. Pan Afr Med J. 2014;17:37. Published 2014 Jan 20.
- Akbar DH, Mushtaq M. Clinical profile of stroke:: The experience at King Abdulaziz University Hospital. J Sci Res Med Sci. 2001;3(1):35-38.
- Di Carlo A, Lamassa M, Baldereschi M, Pracucci G, Basile AM, Wolfe CD, Giroud M, Rudd A, Ghetti A, Inzitari D, Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry.European BIOMED Study of Stroke Care Group.Stroke. 2003 May; 34(5):1114-9.
- Caso V, Paciaroni M, Agnelli G, Corea F, Ageno W, Alberti A, Lanari A, Micheli S,Bertolani L, Venti M, Palmerini F, Billeci AM, Comi G, Previdi P, SilvestrelliG. Gender differences in patients with acute ischemic stroke. Womens Health(Lond). 2010 Jan;6(1):51-7.
- Yao XY, Lin Y, Geng JL, et al. Age- and gender-specific prevalence of risk factors in patients with first-ever ischemic stroke in china. Stroke Res Treat. 2012;2012:136398.
- Foerch C, Ghandehari K, Xu G, Kaul S. Exploring gender distribution in patients with acute stroke: A multi-national approach. J Res Med Sci. 2013;18(1):10-6.
- Huliyappa D, Kotrabasappa K. Risk factors and outcome of stroke in young in a tertiary care hospital. Int J Community Med Public Health. 2016;3:323-7.
- Hörnsten C, Weidung B, Littbrand H, et al. High blood pressure as a risk factor for incident stroke among very old people: a population-based cohort study. J Hypertens. 2016;34(10):2059-65.
- Yu JG, Zhou RR, Cai GJ. From hypertension to stroke: mechanisms and potential prevention strategies. CNS Neurosci Ther. 2011 Oct;17(5):577-84.
- Assarzadegan F, Tabesh H, Shoghli A, et al. Relation of Stroke Risk Factors with Specific Stroke Subtypes and Territories. Iran J Public Health. 2015;44(10):1387-94.
- Lee K, Kim EH, Song D, et al. Lenticulostriate Artery Involvement is Predictive of Poor Outcomes in Superficial Middle Cerebral Artery Territory Infarction. Yonsei Med J. 2016;58(1):123-130.
- González Delgado M, Bogousslavsky J. Superficial middle cerebral arteryterritory infarction. Front Neurol Neurosci. 2012;30:111-4.
- Shah B, Bartaula B, Adhikari J, Neupane HS, Shah BP, Poudel G. Predictors of In-hospital Mortality of Acute Ischemic Stroke in Adult Population. J Neurosci Rural Pract. 2017;8(4):591-594.
- Ekeh B, Ogunniyi A, Isamade E, Ekrikpo U. Stroke mortality and its predictors in a Nigerian teaching hospital. Afr Health Sci. 2015;15(1):74-81.
Corresponding Author
Dr. A. Rajendran, M.D., D.M.
Assistant Professor, Department of Neurology, Govt. Thanjavur Medical College Thanjavur, India