Intracranial stenosis in patients with post-ischemic stroke: a case-control study Rizaldy Pinzon1, Andre Dharmawan Wijono1

Rizaldy Pinzon, Andre Dharmawan Wijono

Rizaldy Pinzon
Department of Neurology, School of Medicine, Universitas Kristen Duta Wacana, Yogyakarta, Indonesia

Andre Dharmawan Wijono
Department of Neurology, School of Medicine, Universitas Kristen Duta Wacana, Yogyakarta, Indonesia. Email: dr.andre.dharmawan@gmail.com
Online First: April 01, 2021 | Cite this Article
Pinzon, R., Wijono, A. 2021. Intracranial stenosis in patients with post-ischemic stroke: a case-control study Rizaldy Pinzon1, Andre Dharmawan Wijono1. Bali Medical Journal 10(1): 69-73. DOI:10.15562/bmj.v10i1.1989

Background: Despite its remained position as the main culprit of stroke worldwide, studies on intracranial stenosis in Indonesia are still very limited. It is necessary to research to measure the prevalence and risk factors of intracranial stenosis in post-ischemic stroke.

Method: We conducted case-control research with participants of 234 ischemic stroke patients. Each patient was listed for their risk factors and analyzed for their association with intracranial stenosis. Intracranial circulation was determined by transcranial doppler (TCD) sonography TD-DOP 9000 with a 2-MHz probe. A peak systolic velocity (PSV) of >140cm/s or mean systolic velocity of (MSV) >80cm/s were used as criteria for middle cerebral artery (MCA) stenosis. In contrast, PSV>90 cm/s or MSV>60cm/s were used to determine the posterior circulation stenosis. Statistical analysis used SPSS 18.0 software which The Independent t-test and chi-square test were used to assess significant differences in correlation to intracranial stenosis. P-value <0.05 was statistically significant.

Result: Intracranial stenosis cases were 38%, with the anterior circulation being the most common stenosis location. Hypertension, diabetes mellitus and dyslipidemia were the most often risk factors. Only hypertension with OR=2.97 (95%CI=1.76-4.98) and diabetes mellitus with OR=1.48 (95%CI=1.12-2.43) were positively correlated with increased risk intracranial stenosis.

Conclusion: The occurrence of intracranial stenosis in ischemic stroke patients was high and increased with the presence of hypertension or diabetes mellitus.


Gorelick PB, Wong KS, Bae HJ, Pandey DK. Large artery intracranial occlusive disease: a large worldwide burden but a relatively neglected frontier. Stroke. 2008;39:2396–2399.

Qureshi AI, Feldmann E, Gomez CR, Johnston SC, Kasner SE, Quick DC, et al. Intracranial atherosclerotic disease: an update. Ann Neurol. 2009;66:730–738.

Jeng JS, Tang SC, Liu HM. Epidemiology, diagnosis and management of intracranial atherosclerotic disease. Expert Rev Cardiovasc Ther. 2010;8:1423–1432.

Sung YF, Lee JT, Tsai CL, Lin CC, Hsu YD, Lin JC, et al. Risk Factor Stratification for Intracranial Stenosis in Taiwanese Patients With Cervicocerebral Stenosis. J Am Heart Assoc. 2015;4(12):e002692.

Wong LK. Global burden of intracranial atherosclerosis. Int J Stroke. 2006; 1:158–159.

Chen HX, Wang LJ, Yang Y, Yue FX, Chen LM, Xing YQ. The prevalence of intracranial stenosis in patients at low and moderate risk of stroke. Ther Adv Neurol Disord. 2019;12:1–11.

Sacco RL, Kargman DE, Gu Q, Zamanillo MC. Race‐ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke. 1995;26:14–20.

Wang Y, Zhao X, Liu L, Soo YO, Pu Y, Pan Y, et al. Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China: the Chinese intracranial atherosclerosis (CICAS) study. Stroke. 2014;45:663–669.

Zhang S, Zhou Y, Zhang Yet, Gao X, Zhang Q, Wang A, et al. Prevalence and risk factors of asymptomatic intracranial arterial stenosis in a community-based population of Chinese adults. Eur J Neurol. 2013;20:1479–1485.

Wong KS, Huang YN, Yang HB, Gao S, Li H, Liu JY, et al. A door-to-door survey of intracranial atherosclerosis in Liangbei County, China. Neurology. 2007;68:2031–2034.

Wong KS, Ng PW, Tang A, Liu R, Yeung V, Tomlinson B. Prevalence of asymptomatic intracranial atherosclerosis in high-risk patients. Neurology. 2007;68:2035–2038.

Park KY, Chung CS, Lee KH, Kim GM, Kim YB, Oh K. Prevalence and risk factors of intracranial atherosclerosis in an asymptomatic Korean population. J Clin Neurol. 2006;2:29–33.

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

Sarkar S, Ghosh S, Ghosh SK, Collier A. Role of transcranial doppler ultrasonography in stroke. Postgrad Med J. 2007;83:683-9.

Wong KS, Li H, Chan YL, Ahuja A, Lam WW, Wong A, et al. Use of transcranial Doppler ultrasound to predict outcome in patients with intracranial large-artery occlusive disease. Stroke. 2000;31:2641–2647.

Felberg RA, Christou I, Demchuk AM, Malkoff M, Alexandrov AV. Screening for intracranial stenosis with transcranial Doppler: the accuracy of mean flow velocity thresholds. J Neuroimaging. 2002;12:9-14.

Li H, Lam WW, Wong KS. Distribution of intracranial vascular lesion in the posterior circulation among Chinese stroke patients. Neurol Asia. 2002;7:65-9.

Lopez-Cancio E, Dorado L, Millan M, Reverté S, Suñol A, Massuet A, et al. The Barcelona-asymptomatic intracranial atherosclerosis (ASIA) study: prevalence and risk factors. Atherosclerosis. 2012;221:221–225.

Turan TN, Makki AA, Tsappidi S, Cotsonis G, Lynn MJ, Cloft HJ, et al. Risk factors associated with severity and location of intracranial arterial stenosis. Stroke. 2010 Aug;41(8):1636-40.

Banerjee C, Chimowitz MI. Stroke Caused by Atherosclerosis of the Major Intracranial Arteries. Circ Res. 2017;120:502-513.

Mazighi M, Tanasescu R, Ducrocq X, Vicaut E, Bracard S, Houdart E, et al. Prospective study of symptomatic atherothrombotic intracranial stenoses: the GESICA study. Neurology. 2006;66:1187–1191.

Qureshi AI, Caplan LR. Intracranial atherosclerosis. Lancet. 2014;383:984–998.

Williams JE, Chimowitz MI, Cotsonis GA, Lynn MJ, Waddy SP. Gender differences in outcomes among patients with symptomatic intracranial arterial stenosis. Stroke. 2007;38:2055-62.

Liebeskind DS, Laughton AL, Kim D, Starkman S, Salamon N, Villablanca P, et al. Vessel size explains gender differences in response to intravenous thrombolysis for acute stroke. Stroke. 2006;37:622- 9.

Chang KC, Chuang IC, Huang YC, Wu CY, Lin WC, Kuo YL, et al. Risk factors outperform intracranial large artery stenosis predicting unfavorable outcomes in patients with stroke. BMC Neurology. 2019;19:180.

Ritz K, Denswil NP, Stam OC, van Lieshout JJ, Daemen MJ. Cause and mechanisms of intracranial atherosclerosis. Circulation. 2014;130:1407–1414.

Chaturvedi S, Turan TN, Lynn MJ, Kasner SE, Romano J, Cotsonis G, et al. Risk factor status and vascular events in patients with symptomatic intracranial stenosis. Neurology. 2007;69:2063–2068.

Meschia JF, Bushnell C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:3754–3832.

Ding X, Li C, Yu K, Gao A, Xiao L, Peng F, et al. Different risk factors between intracranial and extracranial atherosclerotic stenosis in Asian population: a systematic review and meta-analysis. Int J Neurosci. 2014;124:834–840.

Park JH, Hong KS, Lee EJ, Lee J, Kim D. High levels of apolipoprotein B/AI ratio are associated with intracranial atherosclerotic stenosis. Stroke. 2011;42:3040–3046.

Zarei H, Ebrahimi H, Shafiee K, Yazdani M, Aghill K. Intracranial stenosis in patients with acute cerebrovascular accidents. ARYA Atherosclerosis J. 2008;3:206-10.

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