Year: 2024
Type: article
Abstract: Intracranial arterial stenosis (ICAS) is one of the most common causes of stroke globally and presents a significant risk for recurrent stroke compared with other stroke etiologies.1 ICAS is not only associated with stroke but also with various other issues, including dementia. ICAS can lead to reduced blood flow to the brain, potentially causing hypoxia, ischemic damage, and cognitive decline.2 As a complex and multifactorial condition, ICAS is influenced by a range of genetic, biological, and environmental factors.3 The most prevalent risk factors for ICAS include age, hypertension, diabetes mellitus, and dyslipidemia.4 Understanding the significance of ICAS and screening for its early detection are crucial. Indeed, symptoms of arterial stenosis typically appear only after significant damage has occurred, as the process of plaque deposition can be prolonged.5 Early detection could facilitate preventive measures, reduce stroke risk, and delay the onset of complications such as dementia. Mild asymptomatic ICAS is detectable in a substantial proportion of hypertensive patients. For instance, an association between ICAS and hypertension has been recently observed,6 noting that patients with 2 or more stenoses have higher systolic blood pressure in the morning compared with those without stenoses. In this issue of the American Journal of Hypertension, Zhang et al.7 investigated the prevalence and cardiovascular risk factors associated with mild asymptomatic ICAS and assessed the prognostic value for overall and cardiovascular mortality in hypertensive patients. In their cross-sectional and prospective computed tomography angiography (CTA)-based study, they recruited 1,813 patients—1,315 (72.5%) from outpatient clinics and 498 (27.5%) from inpatient wards. The prevalence of mild, moderate, and severe asymptomatic ICAS was 35.7%, 4.3%, and 2.3%, respectively. The follow-up took place at Ruijin Hospital in Shanghai (China) between 2005 and 2015.7 CTA was performed using a 64-section helical CT scanner. CTA enhances diagnosis and treatment planning for ICAS.8 CTA is a micro-invasive imaging method with high sensitivity and specificity compared with the gold standard catheter angiography.9 The procedure involved a single intravenous bolus of 70 ml Optiray Ioversol 320. Patients with allergies to the contrast agent were excluded. The stenosis percentage was calculated using the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) method.10 Intracranial segments of the internal carotid, vertebral, basilar, anterior cerebral, middle cerebral, and posterior cerebral arteries were examined. Stenoses were categorized as 0, 1, 2, or more. Additionally, stenoses were classified as mild (<50% or luminal irregularities), moderate (50%–69%), and severe (≥70% or flow gap). After a follow-up period of 9.2 years, 145 deaths occurred among the study participants (87 cardiovascular, including 43 strokes and 44 cardiac deaths). Kaplan–Meier curves indicated that patients with asymptomatic ICAS had a higher likelihood of dying from any cause, regardless of stenosis degree. Furthermore, patients with multiple stenoses experienced a greater risk of cardiovascular events or death. Specifically, only patients with more than 2 mild stenoses showed increased mortality after adjustment, with a hazard ratio of 2.35 for total mortality and 4.41 for cardiovascular mortality.7 The study also evidenced a significant increase in all-cause and cardiovascular mortality risk, which escalates from mild to severe stenosis compared with no stenosis (Table 1). Main characteristics of the study Abbreviations: CTA, computed tomography angiography; ICAS, intracranial arterial stenosis. Main characteristics of the study Abbreviations: CTA, computed tomography angiography; ICAS, intracranial arterial stenosis. Overall, these findings are pioneering and highly interesting, as to the best of our knowledge no one has previously delved deeply into evaluating the importance of early diagnosis of asymptomatic ICAS.11 Furthermore, the prognostic value of asymptomatic ICAS has not been previously emphasized, whereas Zhang and co-workers have observed a significant prognostic importance in patients affected by it. Furthermore, in this study, in addition to focusing on the prognostic value of these asymptomatic ICAS, an association between the asymptomatic ICAS themselves and modifiable vascular risk factors was demonstrated. This study also has some limitations, including a sample size that could have been larger and the fact that it included only Chinese patients. Additionally, among those with hypertension, only lesions in the cerebral system were evaluated, without considering lesions in other target organs. Despite these limitations, the study by Zhang et al.7 remains a noteworthy study that should be taken as a starting point to encourage the scientific community to pay attention to the prognostic value of asymptomatic ICAS, through the conduct of other similar and more in-depth studies. This work was supported in part by the National Institutes of Health (NIH): National Heart, Lung, and Blood Institute (NHLBI: R01-HL164772, R01-HL159062, R01-HL146691, T32-HL144456, T32-HL172255), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK: R01-DK123259, R01-DK033823), National Center for Advancing Translational Sciences (NCATS: UL1-TR002556-06, UM1-TR004400), by the American Heart Association (AHA, AHA-24IPA1268813, AHA-21POST836407), by the Diabetes Action Research and Education Foundation, and by the Monique Weill-Caulier and Irma T. Hirschl Trusts. The work was also supported in part by the European Union – Next Generation EU, in the context of The National Recovery and Resilience Plan, Project Age-It (Ageing Well in an Ageing Society). The authors declared no conflict of interest.
Source: American Journal of Hypertension
DOI: 10.1093/ajh/hpae100
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: American Heart Association, Diabetes Action Research and Education Foundation, European Commission, National Institutes of Health, National Heart, Lung, and Blood Institute, National Institute of Diabetes and Digestive and Kidney Diseases, National Center for Advancing Translational Sciences
Awards: G1000608447, G1196682224, G1214234794, G1218068299, Molecular regulation of skeletal muscle thermogenesis, G1413706045, G1512127578, G1530010185, G180476886, G186995139, Beta Cell Intracellular Calcium and Diabetes, Functional role of IP3 receptors in the regulation of cardiac myofibroblasts, G249311083, Modulation of Mitofusin Activity to Treat Heart Disease, G280444578, G281933567, G2836354684, G2940288175, A paradigm-shifting idea in storage-disease cardiomyopathy, G3074976661, G3672453180, Einstein-Montefiore Clinical and Translational Science Award Hub, Caspase-9 as a nodal point connecting necrotic and apoptotic cell death in myocardial infarction, Mechanisms of cardiovascular disease, G425922058, G4480573366, CTSA Administrative Supplement for Informatics Core: A novel AI/ML system to predict respiratory failure and ARDS in Covid-19 patients, G522617745, G5298350625, G531307636, G5423166509, G6133271709, G6295426566, G671159905, G6737277850, G7492960808, G7854002418, G790170206, G802470759, G8224181935, Purposeful Outreach for Diversity and Inclusion of Underrepresented in Medicine (PODIUM) Physician-Scientists, G8385843488, G8445767824, G8551577206, G864706750, G873634175, G9000020154, G9000036909, G9000045154, G9000045632, G9000148014, G9000203699, G9000291687, G981417163
OpenAlex ID: W4401242517