Skip to main content

Advertisement

SpringerLink
Log in

Italian symptomatic intracranial atherosclerosis study (ISIDE)

A multicenter transcranial ultrasound evaluation

  • Original Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

There are currently no data available on the prevalence of symptomatic intracranial atherosclerosis (ICAS) in Italy. The aim of this prospective, multicenter, hospital-based, transcranial ultrasound study was to establish the prevalence of ICAS among patients hospitalized with acute ischemic stroke. At 11 stroke centers across Italy, patients consecutively admitted for their first ever acute ischemic stroke were assessed prospectively over a 24-month period either with transcranial color-coded Doppler sonography (TCCS) or transcranial Doppler (TCD) according to validated criteria. ICAS was diagnosed when there was an evidence of a cerebral infarction in the territory of a ≥50 % stenosis detected by TCCS/TCD and confirmed by magnetic resonance angiography or computed tomography angiography. A total of 1134 patients were enrolled, 665 of them (58.6 %) men, with a mean age of 71.2 ± 13.3 years. ICAS was recorded in 99 patients (8.7 % of the whole sample, 8.9 % among Caucasians), most commonly located in the anterior circulation (63 of 99, 5.5 %). After adjusting for potential confounders, multivariate analysis identified carotid/vertebral ≥50 % stenosis [odds ratio (OR) 2.59, 95 % (confidence interval) CI 1.77–6.33; P = 0.02] and hypercholesterolemia (OR 1.38, 95 % CI 1.02–1.89; P = 0.02) as being independently associated with ICAS. ICAS is a surprisingly relevant cause of ischemic stroke in Italy, identified in almost 9 % of first-ever stroke patients. It is more prevalent in the anterior circulation and independently associated with hemodynamically significant cervical vessel atherosclerosis and hypercholesterolemia. These findings support the systematic use of transcranial ultrasound to identify ICAS in patients presenting with acute ischemic stroke and in cases with ≥50 % cervical vessel stenoses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Gorelick PB, Wong KS, Bae HJ, Pandey DK (2008) Large artery intracranial occlusive disease: a large worldwide burden but a relatively neglected frontier. Stroke 39:2396–2399

    Article  PubMed  Google Scholar 

  2. Arenillas JF (2011) Intracranial atherosclerosis: current concepts. Stroke 42:S20–S23

    Article  PubMed  Google Scholar 

  3. Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, Frankel MR et al (2005) Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 352:1305–1316

    Article  CAS  PubMed  Google Scholar 

  4. De Silva DA, Woon FP, Lee MP, Chen CP, Chang HM, Wong MC (2007) South Asian patients with ischemic stroke: intracranial large arteries are the predominant site of disease. Stroke 38(9):2592–2594

    Article  PubMed  Google Scholar 

  5. Sacco RL, Kargman DE, Gu Q, Zamanillo MC (1995) Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan stroke study. Stroke 26:14–20

    Article  CAS  PubMed  Google Scholar 

  6. Wong LKS (2006) Global burden of intracranial atherosclerosis. Int J Stroke 1:158–159

    Article  PubMed  Google Scholar 

  7. Gorelick PB, Caplan LR, Hier DB, Parker SL, Patel D (1984) Racial differences in the distribution of anterior circulation occlusive disease. Neurology 34:54–59

    Article  CAS  PubMed  Google Scholar 

  8. Mazighi M, Labreuche J, Gongora-Rivera F, Duyckaerts C, Hauw JJ, Amarenco P (2008) Autopsy prevalence of intracranial atherosclerosis in patients with fatal stroke. Stroke 39:1142–1147

    Article  PubMed  Google Scholar 

  9. Weimar C, Goertler M, Harms L, Diener HC et al (2006) Distribution and outcome of symptomatic stenoses and occlusions in patients with acute cerebral ischemia. Arch Neurol 63:1287–1291

    Article  PubMed  Google Scholar 

  10. Weber R, Kraywinkel K, Diener HC, Weimar C et al (2010) Symptomatic intracranial atherosclerotic stenoses: prevalence and prognosis in patients with acute cerebral ischemia. Cerebrovasc Dis 30:188–193

    Article  CAS  PubMed  Google Scholar 

  11. Arenillas JF, Molina CA, Chacon P, Rovira A, Montaner J, Coscojuela P et al (2004) High lipoprotein (a), diabetes, and the extent of symptomatic intracranial atherosclerosis. Neurology 63:27–32

  12. Tsivgoulis G, Vadikolias K, Heliopoulos I, Katsibari C, Voumvourakis K, Tsakaldimi S (2012) Prevalence of symptomatic intracranial atherosclerosis in Caucasians: a prospective, multicenter, transcranial Doppler study. J Neuroimaging 24:11–17

    Article  PubMed  Google Scholar 

  13. Meseguer E, Lavallee PC, Mazighi M, Labreuche J, Cabrejo L, Olivot JM et al (2010) Yield of systematic transcranial Doppler in patients with transient ischemic attack. Ann Neurol 68:9–17

    Article  PubMed  Google Scholar 

  14. Balucani C, Leys D, Ringelstein EB, Kaste M, Hacke W et al (2009) Executive committee of the European stroke initiative. Detection of intracranial atherosclerosis: which imaging techniques are available in European hospitals? Stroke 40:726–729

    Article  CAS  PubMed  Google Scholar 

  15. European Stroke Organisation (ESO) Executive Committee, ESO Writing Committee (2008) Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 25:457–507

    Article  Google Scholar 

  16. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C (1991) Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 337:1521–1526

    Article  CAS  PubMed  Google Scholar 

  17. Grant EG, Benson CB, Moneta GL, Alexandrov AV, Baker JD, Bluth EI et al (2003) Carotid artery stenosis: gray-scale and Doppler US diagnosis—Society of Radiologists in Ultrasound Consensus Conference. Radiology 229:340–346

    Article  PubMed  Google Scholar 

  18. Hua Y, Meng XF, Jia LY, Ling C, Miao ZR, Ling F, Liu JB (2009) Color Doppler imaging evaluation of proximal vertebral artery stenosis. Am J Roentgenol 193:1434–1438

    Article  Google Scholar 

  19. Baumgartner RW, Mattle HP, Schroth G (1999) Assessment of ≥50 % and <50 % intracranial stenoses by transcranial color-coded duplex sonography. Stroke 30:87–92

    Article  CAS  PubMed  Google Scholar 

  20. Feldmann E, Wilterdink JL, Kosinski A, Lynn M, Chimowitz MI, Sarafin J et al (2007) The stroke outcomes and neuroimaging of intracranial atherosclerosis (SONIA) trial investigators. The stroke outcomes and neuroimaging of intracranial atherosclerosis (SONIA) trial. Neurology 68:2099–2106

    Article  CAS  PubMed  Google Scholar 

  21. Tsivgoulis G, Sharma VK, Hoover SL, Lao AY, Ardelt AA, Malkoff MD et al (2008) Applications and advantages of power motion-mode Doppler in acute posterior circulation cerebral ischemia. Stroke 39:1197–1204

    Article  PubMed  Google Scholar 

  22. Chimowitz MI, Kokkinos J, Strong J, Brown MB, Levine SR, Silliman S et al (1995) The Warfarin–Aspirin symptomatic intracranial disease study. Neurology 45:1448–1493

    Article  Google Scholar 

  23. Sacco S, Stracci F, Cerone D, Ricci S, Carolei A (2011) Epidemiology of stroke in Italy. Int J Stroke 6:219–227

    Article  PubMed  Google Scholar 

  24. Logallo N, Naess H, Waje-Andreassen, Thomassen L (2014) Prevalence of intracranial stenosis in Norwegian ischemic stroke population. J Stroke Cerebrovasc Dis. 23:1611–1615

    Article  PubMed  Google Scholar 

  25. Mendes I, Baptista P, Soares F, Oliveira V, Ferro JM (1999) Diabetes mellitus and intracranial stenosis. Rev Neurol 28:1030–1033

    CAS  PubMed  Google Scholar 

  26. Bae HJ, Lee J, Park JM, Kwon O, Koo JS, Kim BK et al (2007) Risk factors of intracranial cerebral atherosclerosis among asymptomatics. Cerebrovasc Dis 24:355–360

    Article  PubMed  Google Scholar 

  27. Lopez-Cancio E, Dorado L, Millan M, Reverté S, Suňol A, Massuet A et al (2012) The Barcelona asymptomatic intracranial atherosclerosis (ASIA) study: prevalence and risk factors. Atherosclerosis 221:221–225

    Article  CAS  PubMed  Google Scholar 

  28. Wang Y, Zhao X, Liu L, Soo YOY, Pu Y et al (2014) Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China. The Chinese Intracranial Atherosclerosis (CICAS) Study. Stroke 45:663–669

  29. Wong KS, Huang YN, Yang HB, Gao S, Li H, Liu JY et al (2007) A door-to-door survey of intracranial atherosclerosis in liangbei county, China. Neurology 68:2031–2034

    Article  CAS  PubMed  Google Scholar 

  30. Lee JS, Hong JM, Lee KS, Suh HI, Demchuk AM, Hwang YH et al (2015) Endovascular therapy of cerebral arterial occlusions: intracranial atherosclerosis versus embolism. J Stroke Cerebrovasc Dis. doi:10.1016/j.jstrokecerebrovasdis.2015.05.003 (Epub ahead of print)

  31. Wong KS, Li H (2003) Long-term mortality and recurrent stroke risk among Chinese stroke patients with predominant intracranial atherosclerosis. Stroke 34:2361–2366

    Article  PubMed  Google Scholar 

  32. Brunser AM, Lavados PM, Hoppe A, Lopez J, Valenzuela M, Rivas R (2009) Accuracy of transcranial Doppler compared with CT angiography in diagnosing arterial obstructions in acute ischemic strokes. Stroke 40:2037–2041

    Article  PubMed  Google Scholar 

  33. Tsivgoulis G, Sharma VK, Lao AY, Malkoff MD, Alexandrov AV (2007) Validation of transcranial Doppler with computed tomography angiography in acute cerebral ischemia. Stroke 38:1245–1249

    Article  PubMed  Google Scholar 

  34. Boddu DB, Sharma VK, Bandaru VC, Jyotsna Y, Padmaja D, Suvarna A et al (2011) Validation of transcranial Doppler with magnetic resonance angiography in acute cerebral ischemia. J Neuroimaging 21:e34–e40

    Article  PubMed  Google Scholar 

  35. Homburg PJ, Plas GJ, Rozie S, van der Lugt A, Dippel DW (2011) Prevalence and calcification of intracranial arterial stenotic lesions as assessed with multidetector computed tomography angiography. Stroke 42:1244–1250

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The ISIDE collaborative study group comprised the following investigators: Claudio Baracchini, Filippo Maria Farina, Anna Palmieri, Enzo Ballotta, Giorgio Meneghetti (Padova); Gian Paolo Anzola, Davide Massucco (Coordinating Center, Brescia); Rita Bella, Puglisi Valentina (Catania); Silvia Cenciarelli, Alessia Mattioni, Tatiana Mazzoli, Stefano Ricci (Città di Castello, Perugia); Cinzia Finocchi, Carlo Gandolfo, Massimo Del Sette (Genova); Annalisa Tanzi, Carla Zanferrari (Parma); Giovanni Malferrari, Maria Luisa Zedde (Reggio Emilia); Pietro Caliandro (Roma, Cattolica); Marina Diomedi (Roma, Tor Vergata); Agnese Tonon (Venezia); Massimiliano Braga (Vimercate).

Author information

Authors and Affiliations

  1. Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Via Giustiniani 5, 35128, Padua, Italy

    Claudio Baracchini & Giorgio Meneghetti

  2. Neurologic Clinic and Rehabilitation Department, Casa di Cura Villa Barbarano, Salò, Italy

    Gian Paolo Anzola

  3. UO Neurologia, USL Umbria 1, Ospedale di Città di Castello (PG), Città di Castello, Italy

    Silvia Cenciarelli & Stefano Ricci

  4. UOC Stroke Unit, Dipartimento di Neuroscienze, Fondazione Policlinico Tor Vergata, Rome, Italy

    Marina Diomedi

  5. UOS Malattie Cerebrovascolari Acute, University of Catania, Catania, Italy

    Rita Bella

  6. Divisione di Neurologia, Ospedale SS. Giovanni e Paolo, Venice, Italy

    Agnese Tonon

  7. Stroke Unit, Azienda Ospedaliera di Desio e Vimercate, Vimercate, Italy

    Massimiliano Braga

  8. Stroke Unit, Department of Neuromotor Physiology, Arcispedale Santa Maria Nuova IRCCS Reggio Emilia, Reggio Emilia, Italy

    Maria Luisa Zedde

  9. Neurosonology Service, Department of Neuroscience, University of Parma, Parma, Italy

    Carla Zanferrari

  10. Divisione di Neurologia, Ospedale Galliera, Genoa, Italy

    Massimo Del Sette

  11. Department of Geriatrics, Neuroscience, Orthopedics and Physiatrics, Institute of Neurology, Catholic University, Rome, Italy

    Pietro Caliandro

  12. Stroke Unit, University of Genoa, DINOGMI, Genoa, Italy

    Carlo Gandolfo

Authors
  1. Claudio Baracchini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gian Paolo Anzola
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Silvia Cenciarelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marina Diomedi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rita Bella
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Agnese Tonon
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Massimiliano Braga
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Maria Luisa Zedde
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Carla Zanferrari
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Massimo Del Sette
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Pietro Caliandro
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Carlo Gandolfo
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Stefano Ricci
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Giorgio Meneghetti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Claudio Baracchini.

Ethics declarations

Conflict of interest

This study did not receive any corporate sponsorship and/or government/institutional funding.

Dr. Claudio Baracchini reports no disclosures and conflicts of interest.

Dr. Gian Paolo Anzola reports no disclosures and conflicts of interest.

Dr. Silvia Cenciarelli reports no disclosures and conflicts of interest.

Dr. Marina Diomedi reports no disclosures and conflicts of interest.

Dr. Rita Bella reports no disclosures and conflicts of interest.

Dr. Agnese Tonon reports no disclosures and conflicts of interest.

Dr. Massimiliano Braga reports no disclosures and conflicts of interest.

Dr. Maria Luisa Zedde reports no disclosures and conflicts of interest.

Dr. Carla Zanferrari reports no disclosures and conflicts of interest.

Dr. Massimo Del Sette reports no disclosures and conflicts of interest.

Dr. Pietro Caliandro reports no disclosures and conflicts of interest.

Dr. Carlo Gandolfo reports no disclosures and conflicts of interest.

Dr. Stefano Ricci reports no disclosures and conflicts of interest.

Dr. Giorgio Meneghetti reports no disclosures and conflicts of interest.

Ethical statement

This study has been approved by the local ethics committee of every recruitment center and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Additional information

Members of “ISIDE Investigators” are listed in acknowledgements.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Baracchini, C., Anzola, G.P., Cenciarelli, S. et al. Italian symptomatic intracranial atherosclerosis study (ISIDE). Neurol Sci 37, 1645–1651 (2016). https://doi.org/10.1007/s10072-016-2642-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-016-2642-6

Keywords

Search

Navigation