Key result
Markedly elevated Lp(a) in ICAS links to severe microangiopathy and worse discharge functional outcome.
Why the study?
Does markedly elevated Lipoprotein(a) worsen clinical and imaging outcomes in patients with intracranial arterial stenosis?
Cohort (n=162)
Does markedly elevated Lipoprotein(a) worsen clinical and imaging outcomes in patients with intracranial arterial stenosis?
p-value: p=0.003
In patients with intracranial arterial stenosis, markedly elevated Lp(a) is associated with more severe cerebral microangiopathy and poorer functional outcome at discharge, suggesting a potential role in risk stratification.
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.
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Antonenko et al. (2026) conducted a cohort in Intracranial atherosclerotic stenosis (ICAS) (n=162). Markedly elevated lipoprotein(a) (≥125 nmol/L) vs. Normal/moderately elevated lipoprotein(a) (<125 nmol/L) was evaluated on Functional outcome (mRS) at discharge (p=0.003). Markedly elevated Lp(a) in ICAS patients was not associated with ICAS burden but was linked to more severe cerebral microangiopathy and poorer functional outcome at discharge (p=0.003).
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