Journal of Thrombosis and Thrombolysis

, Volume 34, Issue 3, pp 310–317

The relationship between intracranial arterial stenosis and glomerular filtration rate



Poor renal function is associated with cardiovascular complications attributable to large-vessel diseases such as arterial calcification, heart failure, myocardial infarction, and cardiac mortality. The aim of this study was to evaluate the association between renal function and intracranial arterial stenosis (IAS). We analyzed the records of 283 stroke-free Korean adults (≥45 years of age) who underwent brain 3D time-of-flight magnetic resonance angiography as part of their voluntary health check. The presence of stenosis in the basilar artery and in the horizontal portion of the middle cerebral artery was defined as narrowing of the luminal diameter by 25% or more or occlusion on brain magnetic resonance angiography. We estimated the glomerular filtration rate using the Modification of Diet in Renal Disease equation. The subjects were 133 men and 150 women (mean age of 56 ± 7 years). One hundred sixty-six subjects (59 %) had IAS. The serum creatinine concentration in the highest quartile compared with the lowest quartile was associated with increased prevalence of IAS; the eGFR in the upper two quartiles compared with the lowest quartile were associated with decreased prevalence of IAS. The prevalence of subjects with a high eGFR decreased significantly with the severity of IAS. In conclusion, poor renal function is associated with the presence and the degree of IAS in stroke-free Korean adults.


Basilar artery Glomerular filtration rate Intracranial artery Renal function 


  1. 1.
    Feldmann E, Daneault N, Kwan E, Ho KJ, Pessin MS, Langenberg P, Caplan LR (1990) Chinese-white differences in the distribution of occlusive cerebrovascular disease. Neurology 40:1541–1545PubMedCrossRefGoogle Scholar
  2. 2.
    Sacco RL, Kargman DE, Gu Q, Zamanillo MC (1995) Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction: the northern Manhattan stroke study. Stroke 26:14–20PubMedCrossRefGoogle Scholar
  3. 3.
    Chimowitz MI, Kokkinos J, Strong J, Brown MB, Levine SR, Silliman S, Pessin MS, Weichel E, Sila CA, Furlan AJ et al (1995) The warfarin–aspirin symptomatic intracranial disease study. Neurology 45:1488–1493PubMedCrossRefGoogle Scholar
  4. 4.
    Collins AJ, Kasiske B, Herzog C, Chen SC, Everson S, Constantini E, Grimm R, McBean M, Xue J, Chavers B, Matas A, Manning W, Louis T, Pan W, Liu J, Li S, Roberts T, Dalleska F, Snyder J, Ebben J, Frazier E, Sheets D, Johnson R, Li S, Dunning S, Berrini D, Guo H, Solid C, Arko C, Daniels F, Wang X, Forrest B, Gilbertson D, St Peter W, Frederick P, Eggers P, Agodoa L (2003) Excerpts from the United States Renal Data System 2003 Annual Data Report: atlas of end-stage renal disease in the United States. Am J Kidney Dis 42:A5–A7, S1-230Google Scholar
  5. 5.
    Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH (2004) Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med 164:659–663PubMedCrossRefGoogle Scholar
  6. 6.
    Mann JF, Gerstein HC, Pogue J, Bosch J, Yusuf S (2001) Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial. Ann Intern Med 134:629–636PubMedGoogle Scholar
  7. 7.
    Ovbiagele B (2008) Impairment in glomerular filtration rate or glomerular filtration barrier and occurrence of stroke. Arch Neurol 65:934–938PubMedCrossRefGoogle Scholar
  8. 8.
    Desbien AM, Chonchol M, Gnahn H, Sander D (2008) Kidney function and progression of carotid intima-media thickness in a community study. Am J Kidney Dis 51:584–593PubMedCrossRefGoogle Scholar
  9. 9.
    Ishizaka N, Ishizaka Y, Toda E, Koike K, Seki G, Nagai R, Yamakado M (2007) Association between chronic kidney disease and carotid intima-media thickening in individuals with hypertension and impaired glucose metabolism. Hypertens Res 30:1035–1041PubMedCrossRefGoogle Scholar
  10. 10.
    Ishizaka Y, Ishizaka N, Tani M, Toda A, Toda E, Koike K, Yamakado M (2008) Relationship between albuminuria, low eGFR, and carotid atherosclerosis in Japanese women. Kidney Blood Press Res 31:164–170PubMedCrossRefGoogle Scholar
  11. 11.
    Rodondi N, Yerly P, Gabriel A, Riesen WF, Burnier M, Paccaud F, Bovet P (2007) Microalbuminuria, but not cystatin C, is associated with carotid atherosclerosis in middle-aged adults. Nephrol Dial Transplant 22:1107–1114PubMedCrossRefGoogle Scholar
  12. 12.
    Zhang L, Zhao F, Yang Y, Qi L, Zhang B, Wang F, Wang S, Liu L, Wang H (2007) Association between carotid artery intima-media thickness and early-stage CKD in a Chinese population. Am J Kidney Dis 49:786–792PubMedCrossRefGoogle Scholar
  13. 13.
    Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, Hogg RJ, Perrone RD, Lau J, Eknoyan G (2003) National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 139:137–147PubMedGoogle Scholar
  14. 14.
    Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130:461–470PubMedGoogle Scholar
  15. 15.
    Park HY, Yun KH, Park DS (2009) Levels of soluble receptor for advanced glycation end products in acute ischemic stroke without a source of cardioembolism. J Clin Neurol 5:126–132.PubMedCrossRefGoogle Scholar
  16. 16.
    Kang K, Lee SH, Yoon BW (2009) Basilar artery steno-occlusive disease is associated with structural changes in the left ventricle. Acta Cardiol 64:493–498PubMedCrossRefGoogle Scholar
  17. 17.
    Uehara T, Mori E, Tabuchi M, Ohsumi Y, Yamadori A (1994) Detection of occlusive lesions in intracranial arteries by three-dimensional time-of-flight magnetic resonance angiography. Cerebrovasc Dis 4:365–370CrossRefGoogle Scholar
  18. 18.
    Kwon SU, Cho YJ, Koo JS, Bae HJ, Lee YS, Hong KS, Lee JH, Kim JS (2005) Cilostazol prevents the progression of the symptomatic intracranial arterial stenosis: the multicenter double-blind placebo-controlled trial of cilostazol in symptomatic intracranial arterial stenosis. Stroke 36:782–786PubMedCrossRefGoogle Scholar
  19. 19.
    Shimizu K, Shimomura K, Tokuyama Y, Sakurai K, Isahaya K, Takaishi S, Kato B, Usuki N, Shimizu T, Yamada K, Hasegawa Y (2011) Association between inflammatory biomarkers and progression of intracranial large artery stenosis after ischemic stroke. J Stroke Cerebrovasc Dis doi: 10.1016/j.jstrokecerebrovasdis.2011.07.019
  20. 20.
    Lee EJ, Choi KH, Ryu JS, Jeon SB, Lee SW, Park SW, Park SJ, Lee JW, Choo SJ, Chung CH, Jung SH, Kang DW, Kim JS, Kwon SU (2011) Stroke risk after coronary artery bypass graft surgery and extent of cerebral artery atherosclerosis. J Am Coll Cardiol 57:1811–1818PubMedCrossRefGoogle Scholar
  21. 21.
    Lee M, Saver JL, Chang KH, Liao HW, Chang SC, Ovbiagele B (2010) Low glomerular filtration rate and risk of stroke: meta-analysis. BMJ 341: c4249Google Scholar
  22. 22.
    Yahalom G, Schwartz R, Schwammenthal Y, Merzeliak O, Toashi M, Orion D, Sela BA, Tanne D (2009) Chronic kidney disease and clinical outcome in patients with acute stroke. Stroke 40:1296–1303PubMedCrossRefGoogle Scholar
  23. 23.
    Bugnicourt JM, Chillon JM, Massy ZA, Canaple S, Lamy C, Deramond H, Godefroy O (2009) High prevalence of intracranial artery calcification in stroke patients with CKD: a retrospective study. Clin J Am Soc Nephrol 4:284–290PubMedCrossRefGoogle Scholar
  24. 24.
    Yasaka M, Yamaguchi T, Shichiri M (1993) Distribution of atherosclerosis and risk factors in atherothrombotic occlusion. Stroke 24:206–211PubMedCrossRefGoogle Scholar
  25. 25.
    Caplan LR, Gorelick PB, Hier DB (1986) Race, sex and occlusive cerebrovascular disease: a review. Stroke 17:648–655PubMedCrossRefGoogle Scholar
  26. 26.
    Schrier RW (2006) Role of diminished renal function in cardiovascular mortality: marker or pathogenetic factor? J Am Coll Cardiol 47:1–8PubMedCrossRefGoogle Scholar
  27. 27.
    Shlipak MG, Fried LF, Crump C, Bleyer AJ, Manolio TA, Tracy RP, Furberg CD, Psaty BM (2003) Elevations of inflammatory and procoagulant biomarkers in elderly persons with renal insufficiency. Circulation 107:87–92PubMedCrossRefGoogle Scholar
  28. 28.
    Schiffrin EL, Lipman ML, Mann JF (2007) Chronic kidney disease: effects on the cardiovascular system. Circulation 116:85–97PubMedCrossRefGoogle Scholar
  29. 29.
    Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, Kusek JW, Van Lente F (2006) Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 145:247–254PubMedGoogle Scholar
  30. 30.
    Rule AD, Larson TS, Bergstralh EJ, Slezak JM, Jacobsen SJ, Cosio FG (2004) Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease. Ann Intern Med 141:929–937PubMedGoogle Scholar
  31. 31.
    Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, McCullough PA, Kasiske BL, Kelepouris E, Klag MJ, Parfrey P, Pfeffer M, Raij L, Spinosa DJ, Wilson PW (2003) Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation 108:2154–2169PubMedCrossRefGoogle Scholar
  32. 32.
    Shlipak MG, Sarnak MJ, Katz R, Fried LF, Seliger SL, Newman AB, Siscovick DS, Stehman-Breen C (2005) Cystatin C and the risk of death and cardiovascular events among elderly persons. N Engl J Med 352:2049–2060PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of NeurologyEulji General Hospital, Eulji UniversitySeoulRepublic of Korea
  2. 2.Department of NeurologyGyeongsang National University HospitalJinjuRepublic of Korea
  3. 3.Department of Internal MedicineEulji General Hospital, Eulji UniversitySeoulRepublic of Korea

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