Intracranial carotid arteriosclerosis and their prognosis in intracerebral hemorrhage.

Background: Intracerebral hemorrhage (ICH) is a manifestations of sporadic cerebral small vessel disease, and the survivors are predisposed to higher long-term risks of vascular events. Intracranial carotid artery calcification (ICAC), a potential marker for arteriosclerosis, is a risk factor for stroke but their roles in ICH is unknown. We aimed to investigate the prevalence and morphological subtypes of ICAC and their associations with long-term vascular events in ICH survivors.

Materials and methods: Survivors of spontaneous ICH treated at a single center in Taiwan were included. ICAC was assessed by non-contrast CT; morphology was evaluated and categorized as intimal, internal elastic lamina (IEL), or mixed subtype. Patients were followed up for two years. Associations between calcification subtypes and follow-up events (stroke, cardiovascular event, death) were explored using multivariable Cox regression models.

Results: Overall, 462 (80.1%) survivors of ICH had ICAC-223 (38.6%) were categorized as IEL calcification, 216 (37.4%) as intimal calcification, and 23 (4.0%) as mixed type calcification-and 115 patients (19.9%) had no calcification. Patients with IEL calcification were older than patients with intimal or no calcification (p < 0.001). Age (p < 0.001), diabetes (p = 0.010), and reduced renal function (p = 0.001) were independently associated with IEL calcification. During 2-years of follow-up, IEL calcification was not associated with a significant difference in the risk of recurrent ICH (HR=2.8 [0.8‒9.7]), but was associated with higher risks of incident ischemic stroke (HR = 9.0 [1.0‒77.4]), vascular mortality (HR = 13.6 [1.7‒1772.4], and all-cause mortality (HR = 13.9 [1.8‒105.8]).

Conclusions: ICAC is common among ICH survivors and the subtype of IEL calcification may potentially have prognostic value for long-term vascular events.