Association between coexisting intracranial artery and extracranial carotid artery atherosclerotic diseases and ipsilateral cerebral infarction: a Chinese Atherosclerosis Risk Evaluation (CARE- II) study

Background To evaluate the association between coexisting intracranial and extracranial carotid artery atherosclerotic diseases and ipsilateral acute cerebral infarct(ACI)in symptomatic patients by using magnetic resonance(MR)vessel wall imaging.Methods Symptomatic patients were recruited from a cross-sectional,multicentre study of Chinese Atherosclerosis Risk Evaluation(CARE-II).All patients underwent MR imaging for extracranial carotid arterial wall,intracranial artery and brain.Coexisting intracranial stenosis≥50%and extracranial carotid artery mean wall thickness(MWT)≥1 mm and plaque compositions at the same side were evaluated and the ipsilateral ACI was identified.The association between coexisting atherosclerotic diseases and ACI was evaluated using logistic regression.Results 351 patients were recruited.Patients with ipsilateral ACI had significantly greater prevalence of coexisting intracranial stenosis≥50%and carotid MWT≥1 mm(20.5%vs 4.9%,p<0.001),calcification(15.1%vs 4.4%,p=0.001)and lipid-rich necrotic core(LRNC)(19.2%vs 7.8%,p=0.002)compared with those without.Coexisting intracranial artery stenosis≥50%and carotid MWT≥1 mm(OR 5.043,95%CI 2.378 to 10.694;p<0.001),calcification(OR 3.864,95%CI 1.723 to 8.664;p=0.001)and LRNC(OR 2.803,95%CI 1.455 to 5.401;p=0.002)were significantly associated with ipsilateral ACI.After adjusting for confounding factors,the aforementioned associations remained statistically significant(intracranial stenosis≥50%coexisting with carotid MWT≥1 mm:OR 4.313,95%CI 1.937 to 9.601,p<0.001;calcification:OR 3.606,95%CI 1.513 to 8.593,p=0.004;LRNC:OR 2.358,95%CI 1.166 to 4.769,p=0.017).Conclusions Coexistence of intracranial artery severe stenosis and extracranial carotid artery large burden and intraplaque components of calcification and LRNC are independently associated with ipsilateral ACI.Trial registration number https://www.clinicaltrials.gov/.Unique identifier:NCT02017756.