Subtypes of Intracranial Artery Calcification and Ischemic Stroke Severity

BACKGROUND: Intracranial artery calcification, a common radiological finding in patients with ischemic stroke, manifests in various subtypes, including intimal, medial, and mixed patterns. OBJECTIVE: This study aimed to investigate the correlation between intracranial artery calcification subtypes and the extent of neurological disability in patients with ischemic stroke. METHODS: In this prospective observational study, we have included 135 patients, with a mean age of 67.5 ± 12.3 years and 51% were females. With a standardized method using non-contrast computed tomography (NCCT) scans, we have categorized patients into three groups: a) without calcification, b) mainly intimal calcification, and c) predominant medial calcification. Neurological evaluation was assessed by the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) upon admission and discharge. RESULTS: Patients with predominant medial calcification were older than those with intimal calcification and no arterial calcification (73.5 ± 9.7 vs. 64.1 ± 11.7 vs. 59 ± 12.6 years), with a statistically significant difference (P < 0.001). However, mainly intimal calcification in the anterior circulation was linked to higher NIHSS scores at discharge compared to patients with mainly medial or no calcification (7.8 ± 4.6 vs. 5.6 ± 3.8 vs. 6.4 ± 4.4), P = 0.03. In a linear regression model adjusting for age, sex, hypertension, diabetes, renal failure, pulse pressure, blood glucose level, dyslipidemia, smoking, and hospital stay days, intimal calcification was associated with a significantly higher NIHSS score at discharge (β = 4.8, 95% confidence interval (CI): 1.70-7.95, P = 0.003). CONCLUSION: Patterns of arterial calcification in the intracranial arteries represent a marker of clinical outcomes after ischemic stroke, in patients with mainly intimal calcification of the anterior circulation, having higher disability scales at discharge.