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Intracranial Atherosclerosis in Asian Populations

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Ethnic Diversities, Hypertension and Global Cardiovascular Risk

Part of the book series: Updates in Hypertension and Cardiovascular Protection ((UHCP))

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Abstract

Caucasians have a higher incidence rate of extracranial atherosclerosis, whereas African-Americans and Asians have a higher rate of intracranial atherosclerosis. Carotid stenosis was extensively studied in terms of epidemiology, pathophysiology, and treatment. Unfortunately, relatively little is known about intracranial atherosclerosis until recently when modern neuroimaging methods allowed noninvasive screening of susceptible patients. In China, stroke became the first cause of death in 2008, and the prevalence is increasing steadily. In Chinese populations, intracranial atherosclerosis accounts for about 50% of stroke. Similar prevalence was observed in Thailand, Korea, and Singapore. As the majority of the world’s populations are Asians, it is reasonable to conclude that intracranial atherosclerosis is the most common vascular lesion in stroke patients worldwide. This point is now of interest to Europe because the observed ethnic variance in the distribution of cerebral atherosclerosis might require a different approach to screening of high-risk patients belonging to ethnic minorities.

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References

  1. Feldmann E, Daneault N, Kwan E, et al. Chinese-white differences in the distribution of occlusive cerebrovascular disease. Neurology. 1990;40(10):1541–5.

    Article  CAS  PubMed  Google Scholar 

  2. Inzitari D, Hachinski VC, Taylor DW, et al. Racial differences in the anterior circulation in cerebrovascular disease. How much can be explained by risk factors? Arch Neurol. 1990;47(10):1080–4.

    Article  CAS  PubMed  Google Scholar 

  3. Liu LH, Caplan LR, Kwan E, et al. Racial differences in ischemic cerebrovascular disease: clinical and magnetic resonance angiographic correlations of white and Asian patients. J Stroke Cerebrovasc Dis. 1996;6(2):79–84.

    Article  CAS  PubMed  Google Scholar 

  4. Liu L, Wang D, Wong KS, et al. Stroke and stroke care in China: huge burden, significant workload, and a national priority. Stroke. 2011;42(12):3651–4.

    Article  PubMed  Google Scholar 

  5. Wang Z, Hu S, Sang S, et al. Age-period-cohort analysis of stroke mortality in China: data from the global burden of disease study 2013. Stroke. 2017;48(2):271–5.

    Article  PubMed  Google Scholar 

  6. Huang YN, Gao S, Li SW, et al. Vascular lesions in Chinese patients with transient ischemic attacks. Neurology. 1997;48(2):524–5.

    Article  CAS  PubMed  Google Scholar 

  7. Wong KS, Li H, Chan YL, et al. Use of transcranial Doppler ultrasound to predict outcome in patients with intracranial large-artery occlusive disease. Stroke. 2000;31(11):2641–7.

    Article  CAS  PubMed  Google Scholar 

  8. Lee SJ, Cho SJ, Moon HS, et al. Combined extracranial and intracranial atherosclerosis in Korean patients. Arch Neurol. 2003;60(11):1561–4.

    Article  PubMed  Google Scholar 

  9. Suwanwela NC, Chutinetr A. Risk factors for atherosclerosis of cervicocerebral arteries: intracranial versus extracranial. Neuroepidemiology. 2003;22(1):37–40.

    Article  PubMed  Google Scholar 

  10. De Silva DA, Woon FP, Lee MP, et al. South Asian patients with ischemic stroke: intracranial large arteries are the predominant site of disease. Stroke. 2007;38(9):2592–4.

    Article  PubMed  Google Scholar 

  11. Wang Y, Zhao X, Liu L, et al. Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China: the Chinese intracranial atherosclerosis (CICAS) study. Stroke. 2014;45(3):663–9.

    Article  PubMed  Google Scholar 

  12. Wong LK. Global burden of intracranial atherosclerosis. Int J Stroke. 2006;1(3):158–9.

    Article  PubMed  Google Scholar 

  13. Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke. 1993;24(1):35–41.

    Article  PubMed  Google Scholar 

  14. Bang OY, Kim JW, Lee JH, et al. Association of the metabolic syndrome with intracranial atherosclerotic stroke. Neurology. 2005;65(2):296–8.

    Article  CAS  PubMed  Google Scholar 

  15. Bang OY, Lee PH, Yoon SR, et al. Inflammatory markers, rather than conventional risk factors, are different between carotid and MCA atherosclerosis. J Neurol Neurosurg Psychiatry. 2005;76(8):1128–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Kim JS, Nah HW, Park SM, et al. Risk factors and stroke mechanisms in atherosclerotic stroke: intracranial compared with extracranial and anterior compared with posterior circulation disease. Stroke. 2012;43(12):3313–8.

    Article  CAS  PubMed  Google Scholar 

  17. Wong KS, Gao S, Chan YL, et al. Mechanisms of acute cerebral infarctions in patients with middle cerebral artery stenosis: a diffusion-weighted imaging and microemboli monitoring study. Ann Neurol. 2002;52(1):74–81.

    Article  PubMed  Google Scholar 

  18. Lopez-Cancio E, Matheus MG, Romano JG, et al. Infarct patterns, collaterals and likely causative mechanisms of stroke in symptomatic intracranial atherosclerosis. Cerebrovasc Dis. 2014;37(6):417–22.

    Article  PubMed  Google Scholar 

  19. Bang OY. Considerations when subtyping ischemic stroke in Asian patients. J Clin Neurol. 2016;12(2):129–36.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kasner SE, Chimowitz MI, Lynn MJ, et al. Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis. Circulation. 2006;113(4):555–63.

    Article  PubMed  Google Scholar 

  21. Qureshi AI, Caplan LR. Intracranial atherosclerosis. Lancet. 2014;383(9921):984–98.

    Article  PubMed  Google Scholar 

  22. Alexandrov AV, Demchuk AM, Wein TH, et al. Yield of transcranial Doppler in acute cerebral ischemia. Stroke. 1999;30(8):1604–9.

    Article  CAS  PubMed  Google Scholar 

  23. Feldmann E, Wilterdink JL, Kosinski A, et al. The stroke outcomes and neuroimaging of intracranial atherosclerosis (SONIA) trial. Neurology. 2007;68(24):2099–106.

    Article  CAS  PubMed  Google Scholar 

  24. van den Wijngaard IR, Holswilder G, van Walderveen MA, et al. Treatment and imaging of intracranial atherosclerotic stenosis: current perspectives and future directions. Brain Behav. 2016;6(11):e00536.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kieffer SA, Takeya Y, Resch JA, et al. Racial differences in cerebrovascular disease. Angiographic evaluation of Japanese and American populations. Am J Roentgenol Radium Ther Nucl Med. 1967;101(1):94–9.

    Article  CAS  PubMed  Google Scholar 

  26. Tomita T, Mihara H. Cerebral angiographic study on C.V.D. in Japan. Angiology. 1972;23(4):228–39.

    Article  CAS  PubMed  Google Scholar 

  27. White H, Albala BB, Wang CL, et al. Ischemic stroke subtype incidence among whites, blacks, and Hispanics—the northern Manhattan study. Circulation. 2005;111(10):1327–31.

    Article  PubMed  Google Scholar 

  28. Baracchini C, Anzola GP, Cenciarelli S, et al. Italian symptomatic intracranial atherosclerosis study (ISIDE) : a multicenter transcranial ultrasound evaluation. Neurol Sci. 2016;37(10):1645–51.

    Article  PubMed  Google Scholar 

  29. Liu HM, Tu YK, Yip PK, et al. Evaluation of intracranial and extracranial carotid steno-occlusive diseases in Taiwan Chinese patients with MR angiography: preliminary experience. Stroke. 1996;27(4):650–3.

    Article  CAS  PubMed  Google Scholar 

  30. Sung YF, Lee JT, Tsai CL, et al. Risk factor stratification for intracranial stenosis in Taiwanese patients with Cervicocerebral stenosis. J Am Heart Assoc. 2015;4(12):e002692.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Huang HW, Guo MH, Lin RJ, et al. Prevalence and risk factors of middle cerebral artery stenosis in asymptomatic residents in Rongqi County, Guangdong. Cerebrovasc Dis. 2007;24(1):111–5.

    Article  PubMed  Google Scholar 

  32. Wong KS, Huang YN, Yang HB, et al. A door-to-door survey of intracranial atherosclerosis in Liangbei County, China. Neurology. 2007;68(23):2031–4.

    Article  CAS  PubMed  Google Scholar 

  33. Suri MF, Georgiadis AL, Tariq N, et al. Estimated prevalence of acoustic cranial windows and intracranial stenosis in the US elderly population: ultrasound screening in adults for intracranial disease study. Neuroepidemiology. 2011;37(1):64–71.

    Article  PubMed  Google Scholar 

  34. Modesti PA, Castellani S, Calabrese M, et al. Comparison of type 2 diabetes prevalence in Chinese migrants vs Caucasians and new perspectives for screening of cerebrovascular disease in Chinese: a proof of concept study. Diabetes Res Clin Pract. 2017;130:196–203.

    Article  PubMed  Google Scholar 

  35. Wong KS, Ng PW, Tang A, et al. Prevalence of asymptomatic intracranial atherosclerosis in high-risk patients. Neurology. 2007;68(23):2035–8.

    Article  CAS  PubMed  Google Scholar 

  36. Chimowitz MI, Lynn MJ, Derdeyn CP, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med. 2011;365(11):993–1003.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Derdeyn CP, Chimowitz MI, Lynn MJ, et al. Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial. Lancet. 2014;383(9914):333–41.

    Article  PubMed  Google Scholar 

  38. Chimowitz MI, Lynn MJ, Howlett-Smith H, et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med. 2005;352(13):1305–16.

    Article  CAS  PubMed  Google Scholar 

  39. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(7):2160–236.

    Article  PubMed  Google Scholar 

  40. Kwon SU, Cho YJ, Koo JS, et al. 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. 2005;36(4):782–6.

    Article  CAS  PubMed  Google Scholar 

  41. Kwon SU, Hong KS, Kang DW, et al. Efficacy and safety of combination antiplatelet therapies in patients with symptomatic intracranial atherosclerotic stenosis. Stroke. 2011;42(10):2883–90.

    Article  CAS  PubMed  Google Scholar 

  42. Wang X, Lin WH, Zhao YD, et al. The effectiveness of dual antiplatelet treatment in acute ischemic stroke patients with intracranial arterial stenosis: a subgroup analysis of CLAIR study. Int J Stroke. 2013;8(8):663–8.

    Article  PubMed  Google Scholar 

  43. Liu L, Wong KS, Leng X, et al. Dual antiplatelet therapy in stroke and ICAS: subgroup analysis of CHANCE. Neurology. 2015;85(13):1154–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Zaidat OO, Fitzsimmons BF, Woodward BK, et al. Effect of a balloon-expandable intracranial stent vs medical therapy on risk of stroke in patients with symptomatic intracranial stenosis: the VISSIT randomized clinical trial. JAMA. 2015;313(12):1240–8.

    Article  CAS  PubMed  Google Scholar 

  45. Kim YD, Cha MJ, Kim J, et al. Increases in cerebral atherosclerosis according to CHADS2 scores in patients with stroke with nonvalvular atrial fibrillation. Stroke. 2011;42(4):930–4.

    Article  PubMed  Google Scholar 

  46. Turan TN, Makki AA, Tsappidi S, et al. Risk factors associated with severity and location of intracranial arterial stenosis. Stroke. 2010;41(8):1636–40.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Marzewski DJ, Furlan AJ, St Louis P, et al. Intracranial internal carotid artery stenosis: longterm prognosis. Stroke. 1982;13(6):821–4.

    Article  CAS  PubMed  Google Scholar 

  48. Carolei A, Modesti PA. Limb-shaking TIA: on the borders of evidence-based medicine. Intern Emerg Med. 2017;12(5):675–7.

    Article  PubMed  Google Scholar 

  49. Zhou P, Lu Z, Gao P, et al. Efficacy and safety of intensive statin therapy in Chinese patients with atherosclerotic intracranial arterial stenosis: a single-center, randomized, single-blind, parallel-group study with one-year follow-up. Clin Neurol Neurosurg. 2014;120:6–13.

    Article  PubMed  Google Scholar 

  50. Kuroda S, Houkin K. Moyamoya disease: current concepts and future perspectives. Lancet Neurol. 2008;7(11):1056–66.

    Article  PubMed  Google Scholar 

  51. Fujimura M, Bang OY, Kim JS. Moyamoya disease. Front Neurol Neurosci. 2016;40:204–20.

    Article  PubMed  Google Scholar 

  52. Bang OY, Ryoo S, Kim SJ, et al. Adult Moyamoya disease: a burden of intracranial stenosis in east Asians? PLoS One. 2015;10(6):e0130663.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  53. Yonekawa Y, Taub E. Moyamoya disease: status 1998. Neurologist. 1999;5(1):13–23.

    Article  Google Scholar 

  54. Yonekawa Y, Kahn N. Moyamoya disease. Adv Neurol. 2003;92:113–8.

    PubMed  Google Scholar 

  55. Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870–947.

    Article  PubMed  Google Scholar 

  56. Mangiafico S, Pracucci G, Saia V, et al. The Italian registry of endovascular treatment in acute stroke: rationale, design and baseline features of patients. Neurol Sci. 2015;36(6):985–93.

    Article  PubMed  Google Scholar 

  57. Hart RG, Diener HC, Coutts SB, et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. 2014;13(4):429–38.

    Article  PubMed  Google Scholar 

  58. Piepoli MF, Hoes AW, Agewall S, et al. European guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the European Society of Cardiology and Other Societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37(29):2315–81.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Meschia JF, Bushnell C, Boden-Albala B, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(12):3754–832.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, University of Florence, Firenze, Italy

    Pietro Amedeo Modesti, Maria Boddi & Sergio Castellani

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  1. Pietro Amedeo Modesti
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  2. Maria Boddi
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  3. Sergio Castellani
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Correspondence to Pietro Amedeo Modesti .

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Editors and Affiliations

  1. Department of Clinical and Experimental Medicine, University of Florence, Firenze, Italy

    Pietro Amedeo Modesti

  2. University of Warwick, Warwick Medical School, and University, Hospitals Coventry and Warwickshire, NHS Trust, Coventry, UK

    Francesco P. Cappuccio

  3. Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy

    Gianfranco Parati

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Modesti, P.A., Boddi, M., Castellani, S. (2018). Intracranial Atherosclerosis in Asian Populations. In: Modesti, P., Cappuccio, F., Parati, G. (eds) Ethnic Diversities, Hypertension and Global Cardiovascular Risk. Updates in Hypertension and Cardiovascular Protection. Springer, Cham. https://doi.org/10.1007/978-3-319-93148-7_5

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  • DOI: https://doi.org/10.1007/978-3-319-93148-7_5

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