Quantitative CTA vascular calcification, atherosclerosis burden, and stroke mechanism in patients with ischemic stroke

Highlights•The significance of vascular calcification in differentiating stroke mechanisms is incompletely understood.•Vascular calcification was quantified in the 3 major vessel beds (intracranial internal ICA, cervical carotid artery, and aortic arch).•Calcification volumes were higher by increasing the age stratum in each vascular bed.•Calcification volumes were higher in large artery atherosclerosis compared to other stroke mechanisms in younger age category, but not in intermediate and older subsets.AbstractBackgroundVascular calcification is recognized as the advanced stage of atherosclerosis burden. We hypothesized that vascular calcium quantification in CT angiography (CTA) would be helpful to differentiate large artery atherosclerosis (LAA) from other stroke etiology in patients with ischemic stroke.MethodsWe studied 375 acute ischemic stroke patients (200 males, mean age 69.9 years) who underwent complete CTA images of the aortic arch, neck, and head. The automatic artery and calcification segmentation method measured calcification volumes in the intracranial internal carotid artery (ICA), cervical carotid artery, and aortic arch using deep-learning U-net model and region-grow algorithms. We investigated the correlations and patterns of vascular calcification in the different vessel beds among stroke etiology by age category (young: <65 years, intermediate: 65–74 years, older ≥75 years).ResultsNinety-five (25.3%) were diagnosed with LAA according to TOAST criteria. Median calcification volumes were higher by increasing the age category in each vessel bed. One-way ANOVA with Bonferroni correction showed calcification volumes in all vessel beds were significantly higher in LAA compared with other stroke subtypes in the younger subgroup. Calcification volumes were independently associated with LAA in intracranial ICA (OR; 2.89, 95% CI 1.56–5.34, P = .001), cervical carotid artery (OR; 3.40, 95% CI 1.94–5.94, P < .001) and aorta (OR; 1.69, 95%CI 1.01–2.80, P = .044) in younger subsets. By contrast, the intermediate and older subsets did not show a significant relationship between calcification volumes and stroke subtypes.ConclusionAtherosclerosis calcium volumes in major vessels were significantly higher in LAA compared to non-LAA stroke in younger age.