Published Online
on September 18, 2003

A more recent version of this article appeared on October 1, 2003

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Submitted on June 9, 2003
Accepted on June 17, 2003

C-Reactive Protein Predicts Further Ischemic Events in First-Ever Transient Ischemic Attack or Stroke Patients With Intracranial Large-Artery Occlusive Disease

Juan F. Arenillas MD^*; José Álvarez-Sabín MD, PhD; Carlos A. Molina MD, PhD; Pilar Chacón MD, PhD; Joan Montaner MD, PhD; Álex Rovira MD; Bernardo Ibarra MD; and Manuel Quintana

From the Neurovascular Unit (J.F.A., J.A-S., C.A.M., J.M., M.Q.); Lipid Research Unit (P.C.); and Magnetic Resonance (A.R.) and Computed Tomography Unit (B.I.), Department of Neuroradiology, Vall d'Hebron Hospital, Barcelona, Spain.

^* To whom correspondence should be addressed. E-mail: juanfarenillas{at}terra.es.

Background and Purpose--The role of inflammation in intracranial large-artery occlusive disease is unclear. We sought to investigate the relationship between high-sensitivity C-reactive protein (CRP) levels and the risk of further ischemic events in first-ever transient ischemic attack (TIA) or stroke patients with intracranial large-artery occlusive disease.

Methods--Of a total of 127 consecutive first-ever TIA or ischemic stroke patients with intracranial stenoses detected by transcranial Doppler ultrasonography, 71 fulfilled all inclusion criteria, which included angiographic confirmation. Serum high-sensitivity CRP level was determined a minimum of 3 months after the qualifying event. Patients were followed up during 1 year after blood sampling.

Results--Thirteen patients (18.3%) with intracranial large-artery occlusive disease experienced an end point event: 9 cerebral ischemic events, 7 of which were attributable to intracranial large-artery occlusive disease, and 4 myocardial infarctions. Patients in the highest quintile of high-sensitivity CRP level had a significantly higher adjusted odds ratio for new events compared with those in the first quintile (odds ratio, 8.66; 95% CI, 1.39 to 53.84; P=0.01). A high-sensitivity CRP level above the receiver operating characteristic curve cutoff value of 1.41 mg/dL emerged as an independent predictor of new end point events (hazard ratio, 7.14; 95% CI, 1.77 to 28.73; P=0.005) and of further intracranial large-artery occlusive disease-related ischemic events (hazard ratio, 30.67; 95% CI, 3.6 to 255.5; P=0.0015), after adjustment for age, sex, and risk factors. Kaplan-Meier curves showed that a significantly lower proportion of patients with a high-sensitivity CRP >1.41 mg/dL remained free of a new ischemic event (P<0.0001).

Conclusions--High-sensitivity CRP serum level predicts further intracranial large-artery occlusive disease-related and any major ischemic events in patients with first-ever TIA or stroke with intracranial large-artery occlusive disease. These findings are consistent with the hypothesis that inflammation may be involved in the progression and complication of intracranial large-artery occlusive disease.

Key words: atherosclerosis • C-reactive protein • outcome • stenosis • stroke

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