The effect of intracranial arterial calcification on reperfusion therapy in acute stroke patients: a cohort study

Background and purpose: Intracranial arterial calcification (IAC) has been found as a risk factor of ischemic stroke. However, the relationship between IAC patterns (intimal or medial) and clinical outcome of ischemic stroke remains controversial. We aimed to investigate the correlation between IAC patterns and the effects of reperfusion therapy among acute stroke patients. Methods: Consecutive acute ischemic stroke patients who underwent reperfusion therapy were included. IAC was categorized as intimal or medial. Based on its involvement in arteries, IAC was further classified as diffuse or focal. Neurologic dysfunction before and after therapy was assessed by the National Institute of Health stroke scale (NIHSS). Clinical outcome including favorable neurologic outcome (FNO) and early neurologic deterioration (END) were assessed within 10 days after reperfusion therapy. Results: Of 130 patients, 117 had IAC. Intimal IAC was identified in 74.6% patients and medial IAC was present in 64.6% patients. Diffuse IAC was present in 31.5% patients. All diffuse IACs were medial pattern. Diffuse IAC was associated with higher baseline NIHSS ( p =0.011) and less FNO ( p =0.047). Compared with patients with focal or single diffuse IAC, patients with multiple diffuse IAC had higher baseline NIHSS ( p =0.002) and less FNO ( p =0.024). Multivariable linear regression ( p <0.001) and logistic regression ( p =0.027) suggested that multiple diffuse IAC was associated with higher baseline NIHSS and less FNO. No significant association was found between END and different IAC patterns. Conclusions: Multiple diffuse medial IAC may predict severer neurologic dysfunction and a less favorable neurologic outcome after reperfusion therapy in acute stroke patients.