Abstract Background and aims Elevated lipoprotein(a) (Lp(a)) is an established risk factor for atherosclerosis. However, its role in intracranial atherosclerotic stenosis (ICAS) remains unclear. 7-Tesla-MRI enables detailed ICAS assessment. Methods We analyzed 162 ≥50%-ICAS patients (n=84 symptomatic) with best medical management from the prospective Bernese Intracranial Stenosis Study, stratified by Lp(a) levels into normal/moderately elevated (125 nmol/L; n=127) and markedly elevated (≥125 nmol/L; n=35) groups. Associations with risk factors, 3/7T-MRI, and outcome were assessed. Results No significant differences were found between Lp(a) groups and ICAS burden/location (p=0.198/0.709), and most risk factors. Atrial fibrillation was more frequent in the markedly elevated Lp(a) group (16.7% vs.10%; p=0.021) in asymptomatic patients. Markedly elevated Lp(a) was associated with more severe cerebral microangiopathy (p=0.042). Higher Lp(a) levels were linearly associated with poorer functional outcome (mRS) at discharge (p=0.003). 1-year excellent outcome (mRS:0-1) was more frequent in asymptomatic patients (52.1% vs.34.5%; p=0.044), showing a trend (p=0.093) in the normal/moderate Lp(a) group only. 1-year ischaemic strokes (13.6% vs. 0%;p=0.001) occurred in the symptomatic group only. A favorable evolution of 1-year ICAS contrast-enhancement dynamics was more frequent in asymptomatic patients overall (p=0.001) and among patients with normal/moderately elevated Lp(a) levels (p=0.031). Conclusions Markedly elevated Lp(a) in ICAS patients was not associated with ICAS burden/location but with atrial fibrillation, more severe cerebral microangiopathy, and poorer functional outcome at discharge, suggesting Lp(a) may enhance risk stratification in this patient group. Conflict of interest All authors: nothing to disclose.
Antonenko et al. (Fri,) studied this question.
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