Predicting asymptomatic coronary artery stenosis by aortic arch plaque in acute ischemic cerebrovascular disease: beyond the cervicocephalic atherosclerosis?
10.1097/CM9.0000000000000174
- Author:
Xin MA
1
;
Qi KONG
1
;
Chen WANG
2
;
Gary RAJAH
3
;
Yu-Chuan DING
3
;
Yu-Ren ZHANG
4
;
Xiang-Ying DU
2
Author Information
1. Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
2. Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
3. Department of Neurosurgery, Wayne State University School of Medicine, Detroit 48201, USA.
4. Department of Biostatistics, Yale University School of Public Health, New Haven 06520, USA.
- Publication Type:Journal Article
- MeSH:
Aged;
Aorta, Thoracic;
pathology;
Cerebrovascular Disorders;
diagnosis;
Coronary Stenosis;
diagnosis;
Cross-Sectional Studies;
Female;
Humans;
Male;
Middle Aged;
Odds Ratio;
Plaque, Atherosclerotic;
diagnosis;
Risk Factors
- From:
Chinese Medical Journal
2019;132(8):905-913
- CountryChina
- Language:English
-
Abstract:
BACKGROUND:Asymptomatic coronary artery stenosis (ACAS) ≥50% is common in patients with acute ischemic cerebrovascular disease (AICVD), which portends a poor cardiovascular and cerebrovascular prognosis. Identifying ACAS ≥50% early may optimize the clinical management and improve the outcomes of these high-risk AICVD patients. This study aimed to investigate whether aortic arch plaque (AAP), an early atherosclerotic manifestation of brain blood-supplying arteries, could be a predictor for ACAS ≥50% in AICVD.
METHODS:In this cross-sectional study, atherosclerosis of the coronary and brain blood-supplying arteries was simultaneously evaluated using one-step computed tomography angiography (CTA) in AICVD patients without coronary artery disease history. The patients were divided into ACAS ≥50% and non-ACAS ≥50% groups according to whether CTA showed stenosis ≥50% in at least one coronary arterial segment. The AAP characteristics of CTA were depicted from aspects of thickness, extent, and complexity.
RESULTS:Among 118 analyzed patients with AICVD, 29/118 (24.6%) patients had ACAS ≥50%, while AAPs were observed in 86/118 (72.9%) patients. Increased AAP thickness per millimeter (adjusted odds ratio [OR]: 1.56, 95% confidence interval [CI]: 1.18-2.05), severe-extent AAP (adjusted OR: 13.66, 95% CI: 2.33-80.15), and presence of complex AAP (adjusted OR: 7.27, 95% CI: 2.30-23.03) were associated with ACAS ≥50% among patients with AICVD, independently of clinical demographics and cervicocephalic atherosclerotic stenosis. The combination of AAP thickness, extent, and complexity predicted ACAS ≥50% with an area under the receiver-operating characteristic curve of 0.78 (95% CI: 0.70-0.85, P < 0.001). All three AAP characteristics provided additional predictive power beyond cervical and intracranial atherosclerotic stenosis for ACAS ≥50% in AICVD (all P < 0.05).
CONCLUSIONS:Thicker, severe-extent, and complex AAP were significant markers of the concomitant ACAS ≥50% in AICVD, possibly superior to the indicative value of cervical and intracranial atherosclerotic stenosis. As an integral part of atherosclerosis of brain blood-supplying arteries, AAP should not be overlooked in predicting ACAS ≥50% for patients with AICVD.
