ABSTRACT NUMBER: ESOC2026A1431 BURDEN OF INTRACRANIAL ARTERY CALCIFICATION IS ASSOCIATED WITH STROKE ETIOLOGY AND PREDICTS RECURRENCE

Abstract Background and aims Intracranial artery calcification (IAC) is common and associated with increased stroke risk. Recent studies have identified two subtypes of intracranial carotid artery calcification (ICAC), intimal and internal elastic lamina (IEL) calcification. We investigated the association between IAC volume and morphology with TOAST stroke subtypes, extracranial carotid stenosis (ECS) and recurrent stroke risk. Methods We included patients with a diagnosis of TIA or ischemic stroke with non-cardioembolic etiology enrolled in the CONVINCE trial, who had baseline CT of sufficient quality. IAC volume was quantified on non-contrast CT using a threshold of 130 HU and categorized in tertiles. ICAC morphology was determined by histologically validated CT-based criteria. Associations with etiology according to TOAST and ≥ 50% ECS were assessed by Kruskal-Wallis, chi-squared tests and logistic regression. IAC volume as a predictor for recurrent stroke was analyzed by Kaplan–Meier analysis and Cox regression adjusted for baseline characteristics. Results In a cohort of 519 patients, IAC was present in 475 (91.5%). Patients with large-artery atherosclerosis (LAA) exhibited larger IAC volumes and more intimal dominant ICAC morphology compared with lacunar and cryptogenic aetiologies groups (table 1). With increasing IAC volume, the prevalence of ≥50% ECS was greater (P < 0.001; table 2). The highest IAC tertile had an increased risk of recurrent stroke compared with the lowest (aHR 2.56, 95% CI 1.12-5.84; figure 1). Conclusions Patients with TIA/ischaemic stroke due to LAA had higher IAC volumes and intimal dominant calcification compared with those with lacunar and cryptogenic aetiologies. Increased intracranial artery calcification burden is associated with risk of recurrent stroke. Conflict of interest Tim Cassidy should also be considered an author. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. Table 1 - belongs to Results Table 2 - belongs to Results Figure 1 - belongs to Conclusions