(Stroke. 1996;27:1974-1980.)
© 1996 American Heart Association, Inc.
Articles |
Race and Sex Differences in the Distribution of Cerebral Atherosclerosis
the Division of Neurology (R.J.W., D.L., B.L.), Department of Medicine, and Department of Radiology (H.A.), Sinai Hospital of Baltimore, and the Department of Neurology (R.J.W., B.L.) and Departments of Medicine and Epidemiology (M.K., J.C.), The Johns Hopkins University School of Medicine, Baltimore, Md.
Correspondence to Robert J. Wityk, MD, Department of Medicine, Sinai Hospital of Baltimore, 2401 W Belvedere Ave, Baltimore, MD 21215. E-mail rwityk@welchlink.welch.jhu.edu.
Background and Purpose The purpose of this study was to assess the influence of race, sex, and other risk factors on the location of atherosclerotic occlusive lesions in cerebral vessels. Previous angiographic studies of patients with stroke or transient ischemic attack (TIA) suggest that extracranial atherosclerosis is more common in whites and intracranial disease is more common in blacks. Noninvasive techniques such as duplex ultrasound, transcranial Doppler (TCD), and magnetic resonance angiography (MRA) allow vascular assessment of a more representative proportion of patients than does conventional angiography alone.
Methods Consecutive patients evaluated at a community hospital for stroke or TIA over a 2-year period were reviewed. Lesions were defined as a 50% or greater atherosclerotic stenosis by angiography, duplex ultrasound, or TCD, or a moderate stenosis by MRA.
Results Whites were more likely than blacks to have extracranial carotid artery lesions (33% versus 15%, P=.001), but the proportion of patients with intracranial lesions was similar (24% versus 22%). Men were more likely to have intracranial lesions than women (29% versus 14%, P=.03). When multivariate logistic regression analysis was used, white race was the only predictor for extracranial carotid artery lesions, and male sex was the only predictor for intracranial lesions. The cause of stroke/TIA was extracranial carotid artery disease in 8% and intracranial disease in 8% of all patients in the study.
Conclusions The distribution of cerebral atherosclerosis is influenced by race and sex but not by other vascular risk factors. In our patient population, intracranial disease is as common a cause of cerebral ischemia as extracranial carotid disease.
Key Words: atherosclerosis • carotid arteries • cerebral arteries • racial differences
This article has been cited by other articles:
 |
|
 |
|
  C. Ellis Does Race/Ethnicity Really Matter in Adult Neurogenics? Am J Speech Lang Pathol, November 1, 2009; 18(4): 310 - 314. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T J Wolfe, B F Fitzsimmons, S I Hussain, J R Lynch, and O O Zaidat Long term clinical and angiographic outcomes with the Wingspan stent for treatment of symptomatic 50-99% intracranial atherosclerosis: single center experience in 51 cases JNIS, July 3, 2009; (2009) jnis.2009.000331v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Nahab, M. J. Lynn, S. E. Kasner, M. J. Alexander, R. Klucznik, O. O. Zaidat, J. Chaloupka, H. Lutsep, S. Barnwell, M. Mawad, et al. Risk factors associated with major cerebrovascular complications after intracranial stenting Neurology, June 9, 2009; 72(23): 2014 - 2019. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Gunarathne, J. V. Patel, B. Gammon, P. S. Gill, E. A. Hughes, and G. Y.H. Lip Ischemic Stroke in South Asians: A Review of the Epidemiology, Pathophysiology, and Ethnicity-Related Clinical Features Stroke, June 1, 2009; 40(6): e415 - e423. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. M. Meyers, H. C. Schumacher, R. T. Higashida, S. L. Barnwell, M. A. Creager, R. Gupta, C. G. McDougall, D. K. Pandey, D. Sacks, and L. R. Wechsler Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures: A Scientific Statement From the American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Interdisciplinary Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research Circulation, April 28, 2009; 119(16): 2235 - 2249. [Full Text] [PDF]
|
|
|
|
|
|
F. Siddiq, G. Vazquez, M. Z. Memon, M. F. K. Suri, R. A. Taylor, J. C. Wojak, J. C. Chaloupka, and A. I. Qureshi Comparison of Primary Angioplasty With Stent Placement for Treating Symptomatic Intracranial Atherosclerotic Diseases: A Multicenter Study Stroke, September 1, 2008; 39(9): 2505 - 2510. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. O. Zaidat, R. Klucznik, M. J. Alexander, J. Chaloupka, H. Lutsep, S. Barnwell, M. Mawad, B. Lane, M. J. Lynn, M. Chimowitz, et al. The NIH registry on use of the Wingspan stent for symptomatic70-99% intracranial arterial stenosis Neurology, April 22, 2008; 70(17): 1518 - 1524. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D.C. Suh, J.K. Kim, J.W. Choi, B.S. Choi, H.W. Pyun, Y.J. Choi, M.-H. Kim, H.R. Yang, H.I. Ha, S.J. Kim, et al. Intracranial Stenting of Severe Symptomatic Intracranial Stenosis: Results of 100 Consecutive Patients AJNR Am. J. Neuroradiol., April 1, 2008; 29(4): 781 - 785. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. N. Nguyen-Huynh, M. Wintermark, J. English, J. Lam, E. Vittinghoff, W. S. Smith, and S. C. Johnston How Accurate Is CT Angiography in Evaluating Intracranial Atherosclerotic Disease? Stroke, April 1, 2008; 39(4): 1184 - 1188. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Puetz, G. Gahn, U. Becker, D. Mucha, A. Mueller, N.U. Weir, B. Wiedemann, and R. von Kummer Endovascular Therapy of Symptomatic Intracranial Stenosis in Patients With Impaired Regional Cerebral Blood Flow or Failure of Medical Therapy AJNR Am. J. Neuroradiol., February 1, 2008; 29(2): 273 - 280. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A. De Silva, F.-P. Woon, C. P.L.H Chen, H.-M. Chang, and M.-C. Wong Response to Letter by Sheikh Stroke, January 1, 2008; 39(1): e2 - e2. [Full Text] [PDF]
|
|
|
|
|
|
V. K. Sharma, G. Tsivgoulis, A. Y. Lao, M. D. Malkoff, and A. V. Alexandrov Noninvasive Detection of Diffuse Intracranial Disease Stroke, December 1, 2007; 38(12): 3175 - 3181. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Sarkar, S. Ghosh, S. K. Ghosh, and A. Collier Role of transcranial Doppler ultrasonography in stroke Postgrad. Med. J., November 1, 2007; 83(985): 683 - 689. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. E. Williams, M. I. Chimowitz, G. A. Cotsonis, M. J. Lynn, S. P. Waddy, and for the WASID Investigators Gender Differences in Outcomes Among Patients With Symptomatic Intracranial Arterial Stenosis Stroke, July 1, 2007; 38(7): 2055 - 2062. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Liu, W. Li, and Z.-Q. Liu Middle Cerebral Artery Stenosis: Stenting Is One of the Options: Yes Stroke, April 1, 2007; 38(4): 1418 - 1419. [Full Text] [PDF]
|
|
|
|
 |
|
 P M Rothwell Atherothrombosis and ischaemic stroke BMJ, February 24, 2007; 334(7590): 379 - 380. [Full Text] [PDF]
|
|
|
|
 |
|
 E. R. Bates, C. J. D. Babb, D. E. Casey, C. U. Cates, G. R. Duckwiler, T. E. Feldman, W. A. Gray, K. Ouriel, E. D. Peterson, K. Rosenfield, et al. ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (ACCF/SCAI/SVMB/SIR/ASITN Clinical Expert Consensus Document Committee on Carotid Stenting) Vascular Medicine, February 1, 2007; 12(1): 35 - 83. [PDF]
|
|
|
|
 |
|
 American Society of Interventional & Therapeutic N, Society for Cardiovascular Angiography and Interve, Society for Vascular Medicine and Biology, Society of Interventional Radiology, E. R. Bates, J. D. Babb, D. E. Casey Jr, C. U. Cates, G. R. Duckwiler, T. E. Feldman, et al. ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (ACCF/SCAI/SVMB/SIR/ASITN Clinical Expert Consensus Document Committee on Carotid Stenting) J. Am. Coll. Cardiol., January 2, 2007; 49(1): 126 - 170. [Full Text] [PDF]
|
|
|
|
|
|
J.C. Wojak, D.C. Dunlap, K.R. Hargrave, L.A. DeAlvare, H.S. Culbertson, and J.J. Connors III Intracranial angioplasty and stenting: long-term results from a single center. AJNR Am. J. Neuroradiol., October 1, 2006; 27(9): 1882 - 1892. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Weimar, M. Goertler, L. Harms, H.-C. Diener, and for the German Stroke Study Collaboration Distribution and outcome of symptomatic stenoses and occlusions in patients with acute cerebral ischemia. Arch Neurol, September 1, 2006; 63(9): 1287 - 1291. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. I. Freedman, D. W. Bowden, M. M. Sale, C. D. Langefeld, and S. S. Rich Genetic Susceptibility Contributes to Renal and Cardiovascular Complications of Type 2 Diabetes Mellitus Hypertension, July 1, 2006; 48(1): 8 - 13. [Full Text] [PDF]
|
|
|
|
|
|
S. E. Kasner, M. I. Chimowitz, M. J. Lynn, H. Howlett-Smith, B. J. Stern, V. S. Hertzberg, M. R. Frankel, S. R. Levine, S. Chaturvedi, C. G. Benesch, et al. Predictors of Ischemic Stroke in the Territory of a Symptomatic Intracranial Arterial Stenosis Circulation, January 31, 2006; 113(4): 555 - 563. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Intracranial Angioplasty & Stenting for Cerebral Atherosclerosis: A Position Statement of the American Society of Interventional and Therapeutic Neuroradiology, Society of Interventional Radiology, and the American Society of Neuroradiology AJNR Am. J. Neuroradiol., October 1, 2005; 26(9): 2323 - 2327. [Full Text] [PDF]
|
|
|
|
|
|
R. Kern, W. Steinke, M. Daffertshofer, R. Prager, and M. Hennerici Stroke recurrences in patients with symptomatic vs asymptomatic middle cerebral artery disease Neurology, September 27, 2005; 65(6): 859 - 864. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. H. Lee, C. H. Choi, K.-P. Park, S. M. Sung, S. W. Lee, B.-H. Lee, D. H. Kim, H. J. Kim, C. W. Kim, and S. Kim Techniques for Intracranial Stent Navigation in Patients with Tortuous Vessels AJNR Am. J. Neuroradiol., June 1, 2005; 26(6): 1375 - 1380. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. I. Chimowitz, M. J. Lynn, H. Howlett-Smith, B. J. Stern, V. S. Hertzberg, M. R. Frankel, S. R. Levine, S. Chaturvedi, S. E. Kasner, C. G. Benesch, et al. Comparison of Warfarin and Aspirin for Symptomatic Intracranial Arterial Stenosis N. Engl. J. Med., March 31, 2005; 352(13): 1305 - 1316. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. White, B. Boden-Albala, C. Wang, M. S.V. Elkind, T. Rundek, C. B. Wright, and R. L. Sacco Ischemic Stroke Subtype Incidence Among Whites, Blacks, and Hispanics: The Northern Manhattan Study Circulation, March 15, 2005; 111(10): 1327 - 1331. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Saidi and J. M. Murkin Applied Neuromonitoring in Cardiac Surgery: Patient Specific Management Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2005; 9(1): 17 - 23. [Abstract] [PDF]
|
|
|
|
|
|
D. L. Tirschwell, N. L. Smith, S. R. Heckbert, R. N. Lemaitre, W. T. Longstreth Jr., and B. M. Psaty Association of cholesterol with stroke risk varies in stroke subtypes and patient subgroups Neurology, November 23, 2004; 63(10): 1868 - 1875. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Kremer, T Schaettin, D Georgiadis, and R W Baumgartner Prognosis of asymptomatic stenosis of the middle cerebral artery J. Neurol. Neurosurg. Psychiatry, September 1, 2004; 75(9): 1300 - 1303. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. F. Arenillas, C. A. Molina, P. Chacon, A. Rovira, J. Montaner, P. Coscojuela, E. Sanchez, M. Quintana, and J. Alvarez-Sabin High lipoprotein (a), diabetes, and the extent of symptomatic intracranial atherosclerosis Neurology, July 13, 2004; 63(1): 27 - 32. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. T. Schneider, B. Kissela, D. Woo, D. Kleindorfer, K. Alwell, R. Miller, J. Szaflarski, J. Gebel, J. Khoury, R. Shukla, et al. Ischemic Stroke Subtypes: A Population-Based Study of Incidence Rates Among Blacks and Whites Stroke, July 1, 2004; 35(7): 1552 - 1556. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The SSYLVIA Study Investigators Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries (SSYLVIA): Study Results Stroke, June 1, 2004; 35(6): 1388 - 1392. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Sloan, A. V. Alexandrov, C. H. Tegeler, M. P. Spencer, L. R. Caplan, E. Feldmann, L. R. Wechsler, D. W. Newell, C. R. Gomez, V. L. Babikian, et al. Assessment: Transcranial Doppler ultrasonography: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology, May 11, 2004; 62(9): 1468 - 1481. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Gupta, H.C. Schumacher, S. Mangla, P.M. Meyers, H. Duong, A.G. Khandji, R.S. Marshall, J.P. Mohr, and J. Pile-Spellman Urgent endovascular revascularization for symptomatic intracranial atherosclerotic stenosis Neurology, December 23, 2003; 61(12): 1729 - 1735. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. C. Schumacher, K. Tanji, S. Mangla, P. Meyers, J. Pile-Spellman, A. P. Hays, and J.P. Mohr Histopathological Evaluation of Middle Cerebral Artery After Percutaneous Intracranial Transluminal Angioplasty Stroke, September 1, 2003; 34 (9): e170 - e173. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. S. Babiarz, D. M. Yousem, B. A. Wasserman, C. Wu, W. Bilker, and N. J. Beauchamp Jr. Cavernous Carotid Artery Calcification and White Matter Ischemia AJNR Am. J. Neuroradiol., May 1, 2003; 24(5): 872 - 877. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. K. Kapral, H. Wang, P. C. Austin, J. Fang, D. Kucey, B. Bowyer, and J. V. Tu Sex Differences in Carotid Endarterectomy Outcomes: Results From the Ontario Carotid Endarterectomy Registry Stroke, May 1, 2003; 34(5): 1120 - 1124. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Goldstein, D. B. Matchar, J. Hoff-Lindquist, G. P. Samsa, R. D. Horner, and E. J. Kenton III Veterans Administration Acute Stroke (VASt) Study: Lack of Race/Ethnic-Based Differences in Utilization of Stroke-Related Procedures or Services * Diagnostic Disparities: Still Exist? Stroke, April 1, 2003; 34(4): 999 - 1004. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. B. Worrall, K. C. Johnston, G. Kongable, E. Hung, D. Richardson, and P. B. Gorelick Stroke Risk Factor Profiles in African American Women: An Interim Report From the African-American Antiplatelet Stroke Prevention Study Stroke, April 1, 2002; 33(4): 913 - 919. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. F. Arenillas, C. A. Molina, J. Montaner, S. Abilleira, M. A. Gonzalez-Sanchez;, and J. Alvarez-Sabin Progression and Clinical Recurrence of Symptomatic Middle Cerebral Artery Stenosis: A Long-Term Follow-Up Transcranial Doppler Ultrasound Study Stroke, December 1, 2001; 32(12): 2898 - 2904. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. I. Chimowitz Angioplasty or Stenting Is Not Appropriate as First-Line Treatment of Intracranial Stenosis Arch Neurol, October 1, 2001; 58(10): 1690 - 1692. [Full Text] [PDF]
|
|
|
|
|
|
K. S. Wong, H. Li, Y. L. Chan, A. Ahuja, W. W.M. Lam, A. Wong, and R. Kay Use of Transcranial Doppler Ultrasound to Predict Outcome in Patients With Intracranial Large-Artery Occlusive Disease Stroke, November 1, 2000; 31(11): 2641 - 2647. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. L. Lutsep and W. M. Clark Association of intracranial stenosis with cortical symptoms or signs Neurology, September 12, 2000; 55(5): 716 - 718. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. N. Thijs and G. W. Albers Symptomatic intracranial atherosclerosis: Outcome of patients who fail antithrombotic therapy Neurology, August 22, 2000; 55(4): 490 - 498. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. W. Petty, R. D. Brown Jr, J. P. Whisnant, J. D. Sicks, W. M. O’Fallon, and D. O. Wiebers Ischemic Stroke Subtypes : A Population-Based Study of Incidence and Risk Factors Stroke, December 1, 1999; 30(12): 2513 - 2516. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Kroger, A. Kucharczik, H. Hirche, and G. Rudofsky Atherosclerotic Lesions Are More Frequent in Femoral Arteries than in Carotid Arteries Independent of Increasing Number of Risk Factors Angiology, August 1, 1999; 50(8): 649 - 654. [Abstract] [PDF]
|
|
|
|
|
|
R. M. Ahuja, S. Chaturvedi, D. Eliott, N. Joshi, J. E. Puklin, and G. W. Abrams Mechanisms of Retinal Arterial Occlusive Disease in African American and Caucasian Patients Stroke, August 1, 1999; 30(8): 1506 - 1509. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Z. Oddone, R. D. Horner, R. Sloane, L. McIntyre, A. Ward, J. Whittle, L. J. Passman, L. Kroupa, R. Heaney, S. Diem, et al. Race, Presenting Signs and Symptoms, Use of Carotid Artery Imaging, and Appropriateness of Carotid Endarterectomy Stroke, July 1, 1999; 30(7): 1350 - 1356. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. W. Baumgartner, H. P. Mattle, and G. Schroth Assessment of >=50% and <50% Intracranial Stenoses by Transcranial Color-Coded Duplex Sonography Stroke, January 1, 1999; 30(1): 87 - 92. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Prognosis of Patients With Symptomatic Vertebral or Basilar Artery Stenosis Stroke, July 1, 1998; 29(7): 1389 - 1392. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Bruno Are There Differences in Vascular Disease Between Ethnic and Racial Groups? Stroke, January 1, 1998; 29(1): 2 - 3. [Full Text] [PDF]
|
|