Determinants and Outcomes of Asymptomatic Intracranial Atherosclerotic Stenosis

Jose Gutierrez, Farid Khasiyev, Minghua Liu, Janet T. DeRosa, Sarah E. Tom, Tatjana Rundek, Ken Cheung, Clinton B Wright, Ralph L. Sacco, Mitchell S.V. Elkind

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Intracranial atherosclerotic stenosis (ICAS) is one of the most common causes of stroke worldwide and confers a high risk of stroke recurrence, despite aggressive management of risk factors. Objectives: This study identified the role of risk factors and risk of vascular events in subjects with asymptomatic ICAS for improved risk stratification. Methods: Stroke-free participants in the NOMAS (Northern Manhattan Study) trial, prospectively followed since 1993, underwent a brain magnetic resonance angiogram from 2003 to 2008. The study rated stenosis in 11 brain arteries as: 0: no stenosis; 1: <50% or luminal irregularities; 2: 50%-69%; and 3: ≥70% stenosis or flow gap. The study ascertained vascular events during the post-magnetic resonance imaging (MRI) period. Proportional odds regression quantified the association of pre-MRI exposures, and proportional hazard adjusted models were built to identify the risk of events in the post-MRI period. Results: The included sample included 1,211 participants from NOMAS (mean age: 71 ± 9 years; 59% women; 65% Hispanic; 45% had any stenosis). Older age (OR: 1.02 per year; 95% CI: 1.01 to 1.04), hypertension duration (OR: 1.01 per year; 95% CI: 1.00 to 1.02), higher number of glucose-lowering drugs (OR: 1.64 per each medication; 95% CI: 1.24 to 2.15), and high-density lipoprotein (OR: 0.96 per mg/dL; 95% CI: 0.92 to 0.99) were associated with ICAS. The highest event risk was noted among participants with ICAS ≥70% (5.5% annual risk of vascular events; HR: 2.1; 95% CI:1.4 to 3.2; compared with those with no ICAS). Conclusions: ICAS is an imaging marker of established atherosclerotic disease in stroke-free subjects, and incidental diagnosis of ICAS should trigger a thorough assessment of vascular health.

Original languageEnglish (US)
Pages (from-to)562-571
Number of pages10
JournalJournal of the American College of Cardiology
Issue number6
StatePublished - Aug 10 2021


  • arterial stenosis
  • cerebrovascular disease
  • intracranial atherosclerosis
  • risk factor
  • vascular risk

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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