Document Type : Original Article

Authors

1 Professor of Neurology Stroke Fellowship, Neurology Research Center, Kerman Medical University, Kerman, Iran

2 Assistant of Neurology, Neurology Research Center, Kerman Medical University, Kerman, Iran

3 Neurologist, Neurology Research Center, Kerman Medical University, Kerman, Iran

10.48305/arya.2023.11800.2455

Abstract

INTRODUCTION: This study aimed to investigate the frequency of asymptomatic intracranial and extracranial artery stenosis in healthy volunteers in Kerman, Iran, in 2019 using Doppler ultrasound imaging.
METHOD: This cross-sectional study was conducted on healthy volunteers in Kerman in 2019 following a public elicitation. After the general examination, 138 healthy volunteers who had no history of any disease and were not treated with any medication underwent cerebrovascular evaluation with Doppler ultrasound. Demographic information, history of addiction, and sonographic findings were recorded in a checklist and then analyzed using SPSS 22.
RESULTS: Stenosis was found in 14.4% of volunteers. The mean age of participants was 45.8±10.12 years, and 74 (54%) of them were male. In volunteers with stenosis, a significant correlation was found between age (P = 0.03) and addiction (P = 0.04) with the involved artery. There was also a significant correlation between addiction and intracranial and extracranial artery stenosis (P = 0.04). Logistic regression analysis showed a significant relationship between being female, addiction, and age with stenosis, as well as between addiction and intracranial artery stenosis (P <0.05).
CONCLUSION: The majority of healthy residents of Kerman have asymptomatic cerebrovascular stenosis, and this is more prevalent in the elderly, addicts, and women.
 

Keywords

1. Gorelick P. The global burden of stroke: persistent and disabling. Lancet Neurol 2019; 18(5): 417-418.‎ https://doi.org/10.1016/S1474-4422(19)30030-4
2. Navis A, Garcia-Santibanez R, Skliut M. Epidemiology and Outcomes of Ischemic Stroke and Transient Ischemic Attack in the Adult and Geriatric Population. J Stroke Cerebrovasc Dis 2019; 28(1): 84-89. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.09.013
3. Daneshfard B, Izadi S, Shariat A, Toudaji MA, Beyzavi Z, Niknam L. Epidemiology of stroke in Shiraz, Iran. Iran J Neurol 2015; 14(3): 158-63.
4. Saber H, Thrift AG, Kapral MK, Shoamanesh A, Amiri A, Farzadfard MT, et al. Incidence, recurrence, and long-term survival of ischemic stroke ‎subtypes: a population-based study in the Middle East. Int J Stroke 2017; 12(8): 835-843. https://doi.org/10.1177/1747493016684843
5. Ebrahimi HA, Saba M, Sedighi B, Kamali H. Study of the involved vascular ‎territories in patients with ischemic stroke in Kerman, Iran. ARYA Atheroscler 2016; 12(5): 250-3.
6. Grau AJ, Weimar C, Buggle F, Heinrich A, Goertler M, Neumaier S, et al. Risk factors, outcome, and treatment in subtypes of ischemic stroke the german stroke data bank. Stroke 2017; 32(11): 59-66. https://doi.org/10.1161/hs1101.098524
7. Guzik A, Bushnell C. Stroke Epidemiology and Risk Factor Management. Continuum (Minneap Minn) 2017; 23: 15-39. https://doi.org/10.1212/CON.0000000000000416
8. Naqvi J, Yap KH, Ahmad G, Ghosh J. Transcranial Doppler Ultrasound: A Review of the Physical Principles and Major Applications in Critical Care. Int J Vasc Med 2013; 2013: 629378. https://doi.org/10.1155/2013/629378
9. Bots ML, Evans G, Tegeler C, Meijer R. Carotid Intima-media Thickness ‎Measurements: Relations with Atherosclerosis, Risk of Cardiovascular Disease and Application in Randomized Controlled Trials. Chin Med J (Engl) 2016; 129(2): 215. https://doi.org/10.4103/0366-6999.173500
10. Lopez-Cancio E, Dorado L, Millan M, Reverte S, Sunol A, Massuet A, et al. The population-based Barcelona-Asymptomatic Intracranial Atherosclerosis Study (ASIA): rationale and design. BMC Neurol 2011; 11: 22. https://doi.org/10.1186/1471-2377-11-22
11. Lopez-Cancio E, Dorado L, Millan M, Reverte S, Sunol A, Massuet A, et al. The Barcelona-Asymptomatic Intracranial Atherosclerosis (AsIA) study: prevalence and risk factors. Atherosclerosis 2012; 221(1): 221-5. https://doi.org/10.1016/j.atherosclerosis.2011.12.020
12. Bang OY, Kim JW, Lee JH, Lee MA, Lee PH, Joo IS, et al. Association of the metabolic syndrome with intracranial atherosclerotic stroke. Neurology 2005; 65(2): 296-8. https://doi.org/10.1212/01.wnl.0000168862.09764.9f
13. Alexandrov AV. Cerebrovascular Ultrasound in Stroke Prevention and Treatment. 2nd edition. 2011. https://doi.org/10.1002/9781444327373
14. Kamal AK, Majeed F, Pasha O, Islam M, Azam L, Saleem Ilyas M, et al. Study Protocol: Asymptomatic Intracranial Atherosclerotic Disease in Pakistanis. J Vasc Interv Neurol 2015; 8(1): 27-35.
15. Matsui R, Nakagawa T, Takayoshi H, Onoda K, Oguro H, Nagai A, et al. A Prospective Study of Asymptomatic Intracranial Atherosclerotic Stenosis in Neurologically Normal Volunteers in a Japanese Cohort. Front Neurol 2016; 7: 39. https://doi.org/10.3389/fneur.2016.00039
16. Wang Q, Zhao Y, Wang X, Ji X, Sang S, Shao S, et al. Association between asymptomatic intracranial arterial stenosis and insulin resistance or diabetes mellitus: a cross-sectional study in rural Shandong, China. BMJ Open Diabetes Res Care 2020; 8(2): 001788. https://doi.org/10.1136/bmjdrc-2020-001788
17. Jin H, Peng Q, Nan D, Lv P, Liu R, Sun W, et al. Prevalence and risk factors of intracranial and extracranial artery stenosis in asymptomatic rural residents of 13 villages in China. BMC Neurol 2017; 17(1): 136. https://doi.org/10.1186/s12883-017-0924-0
18. Sun Q, Wang Q, Wang X, Ji X, Sang S, Shao S, et al. Prevalence and cardiovascular risk factors of asymptomatic intracranial arterial stenosis: the Kongcun Town Study in Shandong, China. Eur J Neurol 2020; 27(4): 729-735. https://doi.org/10.1111/ene.14144
19. Weerd M, Greving JP, Hedblad B, Lorenz MW, Mathiesen EB, O’Leary DH, et al. Prevalence of asymptomatic carotid artery stenosis in the general population: an individual participant data meta-analysis. Stroke 2010; 41(6): 1294-7. https://doi.org/10.1161/STROKEAHA.110.581058
20. Ding X, Li C, Yu K, Gao A, Xiao L, Peng F, et al. Different risk factors between intracranial and extracranial atherosclerotic stenosis in Asian population: a systematic review and meta-analysis. Int J Neurosci 2014; 124(11): 834-40. https://doi.org/10.3109/00207454.2013.879580
21. Jeon SB, Chun S, Choi-Kwon S, Chi HS, Nah HW, Kwon SU, et al. Biomarkers and location of atherosclerosis: matrix metalloproteinase-2 may be related to intracranial atherosclerosis. Atherosclerosis 2012; 223(2): 442-7. https://doi.org/10.1016/j.atherosclerosis.2012.04.013
22. Watanabe M, Kimura K, Iguchi Y, Shibazaki K, Urabe T, Hattori N. Peripheral arterial atherosclerosis in patients with extracranial, not intracranial, arterial stenosis. Intern Med 2010; 49(15): 1515-9. https://doi.org/10.2169/internalmedicine.49.3434
23. Suwanwela NC, Chutinetr A. Risk factors for atherosclerosis of ‎cervicocerebral arteries: intracranial versus extracranial. Neuroepidemiology 2003; 22(1): 37-40. https://doi.org/10.1159/000067112
24. Saber H, Amiri A, Thrift AG, Stranges S, Shahripour RB, Farzadfard MT, et al. Epidemiology of intracranial and extracranial large artery stenosis in ‎a population-based study of stroke in the Middle East. Neuroepidemiology 2017; 48(3-4): 188-92. https://doi.org/10.1159/000479519
25. Luchowski P, Wojczal J, Buraczynska K, Kozlowicz M, Stazka J, Rejdak K. Predictors of intracranial cerebral artery stenosis in patients before cardiac surgery and its impact on perioperative and long-term stroke ‎risk. Neurol Neurochir Pol 2015; 49(6): 395-400. https://doi.org/10.1016/j.pjnns.2015.09.006
26. Liu HM, Tu YK, Yip PK, Su CT. Evaluation of intracranial and extracranial ‎carotid steno-occlusive diseases in Taiwan Chinese patients with MR ‎angiography: preliminary experience. Stroke 1996; 27(4): 650-3. https://doi.org/10.1161/01.STR.27.4.650
27. Park SY, An SA, Lee HB, Kim Y, Kim N, Kim S, et al. Different impact of hyperhomocysteinemia on cerebral small vessel ischemia and cervicocerebral atherosclerosis in non-stroke individuals. Thromb Res 2013; 131(1): 12-16. https://doi.org/10.1016/j.thromres.2012.11.011
28. Wong KS, Ng PW, Tang A, Liu R, Yeung V, Tomlinson B. Prevalence of asymptomatic intracranial atherosclerosis in high-risk patients. Neurology 2007; 68(23): 2035-8. https://doi.org/10.1212/01.wnl.0000264427.09191.89
‎29. Samai A. A survey of extracranial carotid artery stenosis prevalence in ischemic stroke patients in Kerman. Koomesh 2001; 2(3): 153-159.