ABSTRACT NUMBER: ESOC2026A907 INTRACRANIAL ARTERY STENOSIS – A PATHOLOGY THAT CANNOT BE IGNORED

Abstract Background and aims Although intracranial artery stenoses are less common in Caucasians than Asians, their proportion within intracranial vessels remains significant compared to precerebral stenoses. This study, involving 4,227 patients over three years, assessed the incidence and proportion of atherosclerotic disease in cervicocerebral vessels in stroke patients Methods All patients included underwent evaluation with cerebral CT, cervical and intracranial Doppler ultrasound, as well as subsequent CTA of the supra-aortic trunks. Patients with hemodynamically significant stenoses were defined by exhibiting >50% stenosis, confirmed by Doppler ultrasound and CTA. Results Of the 4,227 patients, 51.45% were female and 48.55% male, with a mean age of 69 years. A total of 3,975 patients (94%) demonstrated at least early atherosclerosis of the carotid and/or vertebral arteries. Among these patients, 28% presented with hemodynamically significant stenoses at the level of precerebral arteries, with the majority of these stenoses being asymptomatic—up to 55%. Approximately 8.9% exhibited intracranial stenoses, with up to 60% of these being symptomatic. Notably, carotid territory stenoses had a higher symptom rate (~70%) compared to vertebrobasilar stenoses (<50%). Furthermore, nearly a quarter (~23%) of those with intracranial stenoses had bilateral involvement. Regarding extracranial stenoses, 4.5% of patients were diagnosed with tandem stenoses, with a ratio of 3:1 favoring the carotid territory. Conclusions The analysis indicates that despite being less frequent, intracranial stenoses have a higher symptomatic proportion than extracranial lesions. The high rate of bilateral intracranial stenoses underscores the importance of thorough intracerebral vessel assessment during routine Doppler examinations to better identify at-risk patients. Conflict of interest Teodor Trinca: nothing to disclose