In this interesting study, Drs. Heo et al address the clinical relevance of overall atherosclerotic burden of cervical and cerebral vessels in ischemic stroke outcome.
More specifically, after excluding patients with cardioembolic etiology they retrospectively studied the short-term clinical improvement measured by NIHSS, as well as 3-month functional outcome, using mRS as a metric. They focus on “non-relevant cerebral atherosclerosis”, that is >50% stenosis or occlusion of vessels not directly implicated in the arterial territory of the infarct. Despite baseline differences in age and some of the risk factors, multivariate adjusted analysis showed less early improvement and worse functional outcome in patients with non-relevant atherosclerosis (adjusted OR of 2.54) . Of interest, exclusively intracranial atherosclerosis showed the strongest association with worse outcome, as opposed to solely extracranial disease that was not a significant predictor.
It is important to note that data regarding recurrent strokes and the status of collateral flow are not available and that is a limitation of the study. Moreover it would be important to know post-stroke treatment choices (i.e. antiplatelet regimen, or if anticoagulation was used in some patients), LDL levels and lipid-lowering regimen choices, as aggressive statin therapy is a treatment of choice in patients with extensive intracranial atherosclerosis.
Despite its limitations, the study results lend support to what most clinicians would suspect intuitively; that “non-relevant” atherosclerosis is in reality quite relevant.