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Background: Intracranial atherosclerosis disease is a cause of ischemic stroke. Risk factors of ICAD included age, gender, race/ethnicity, hypertension, diabetes mellitus, and dyslipidaemia. This study aimed to describe the profile of ICAD in first-ever stroke and its association of recurrent stroke. Methods: The was a prospective cohort study conducted at a private hospital in Indonesia between January 2021 and June 2022. Inclusion criteria included patients with first-ever stroke and intracranial stenosis confirmed through digital subtraction angiography. The incidence of recurrent stroke was observed at six-month follow-up. Results: Of 40 subjects, 25 (62.5%) were females and most ages ranged from 20 to 40 years old. The prevalent site of intracranial stenosis were internal carotid artery in 19 (23.2%) and anterior cerebral artery in 19 (23.2%) subjects. Following six-month follow-up, there was only a patient with recurrent stroke. Conclusions: In first-ever stroke in Indonesia, ICAD was predominantly described in younger men within 41-60 years old. Stroke recurrence was observed in a patient who was old and had multiple comorbid. Further studies using a larger area and longer duration of follow-up may be considered to provide a more generalized description of ICAD in Indonesia.
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Background: Stroke involving extracranial carotid (ECAS), vertebral (EVAS), and intracranial arteries (IAS) contributed to an annual stroke rate of 0.1-3.3%. Even though endarterectomy and/or angioplasty and stenting had revolutionized its� management, best medical treatment (BMT) is still the mainstay of therapy to prevent secondary stroke/transient ischemic attack. This study aimed to evaluate the effect of BMT to reduce the degree of stenosis by using six-months double antiplatelet therapy (DAPT). Methods: A retrospective cohort study was conducted in a secondary private hospital in Indonesia, in January-December 2022. Adults ?18 years old with ECAS, EVAS, or IAS detected using digital subtraction angiography (DSA), receiving DAPT for at least six months, and those who had second DSA evaluation were included. Any subjects with other brain pathologies or recorded incompliance to DAPT were excluded. Age, gender, stenosis degree, stenosis location, and conversion of stenosis degree were recorded and compared between pre-DAPT and post-DAPT group. Results: Of 30 subjects, there were insignificant changes (46.5�.3% to 50.8�.9%, p=0.09) of ECAS, EVAS, and IAS. There were 14 cases with constant stenosis (51.4�.5%), 8 cases with decreasing stenosis (46.9�.2% to 40.1�.8%, p=0.012), and 12 cases with increasing stenosis (40.4�.9% to 57.1�.0%, p=0.002). No significant association were found among those groups related to traditional vascular risk factors. Conclusions: There was no difference in respect to the degree of stenosis following six months of DAPT in either ECAS, EVAS, or IAS. Routine evaluation as well as recognizing features of high-risk stroke/TIA are important to help decide individual who may be candidates of endovascular procedures earlier.
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reduced cerebral blood flow, increased atherosclerosis, and aneurysm formation. This study aimed to describe the profile of vertebral artery hypoplasia (VAH), anterior CAH (ACAH), and posterior CAH (PCAH) in symptomatic subjects. Methods: This was a retrospective cross-sectional study using medical record in a secondary private hospital in Jakarta, Indonesia, in January-December 2022. The inclusion criteria were age ?18 years with neurological symptoms, underwent brain MRI, and being diagnosed with CAH using DSA. The exclusion criteria were findings of other vascular pathologies including dissection and >50% intracranial vessel stenosis. Demographics of age, sex, body mass index (BMI), hypertension, diabetes, cardiac disorder, and previous stroke were analyzed among VAH, PCAH, and ACAH groups. Results: Of 769 subjects with clinical symptoms undergoing DSA, there were 66 (8.6%) cases of intracranial artery hypoplasia, including VAH (4.6%), PCAH (1.2%), and ACAH (2.9%). Subjects were predominantly old (53.2±10.1 years), male (53.0%), with BMI of 24.9±3.9 kg/m2 and hypertension (69.7%). Previous stroke (69.7%) was more prevalent than in previous study (28.1%). Stroke and brain ischemic lesion were detected in 89.4% and 84.8% cases. No differences were found in all parameters among all groups, but posterior circulation symptoms tended to be found in VAH (28.1%) than general stroke (20.3%). Conclusions: The high percentage of recurrent stroke and corresponding clinical symptoms associated with CAH supported that CAH may be a risk factor for clinical symptoms, including stroke, regardless of the involved artery.
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Background: Carotid artery stenosis (CAS) may manifest with stroke, transient ischemic attack (TIA), or more covert non-hemispheric symptoms. While symptoms can be subtle, brain MRI abnormalities may already reflect substantial changes. This study aimed to determine the association between brain MRI abnormalities and symptomatic CAS. Methods: A retrospective cross-sectional study was conducted to subjects with symptomatic ICA stenosis admitted to a private secondary hospital in Jakarta, Indonesia, from January to December 2022. Symptoms were categorized to stroke/TIA and non-hemispheric symptoms (vertigo, headache, presyncope, etc.). Properties of CAS were recorded using digital subtraction angiography report. Brain abnormalities were recorded using MRI report. Results: Brain MRI abnormalities were detected in 96.2% CAS cases and similar between stroke (96.2%) and non-hemispheric symptoms (96.0%). The abnormalities tended to be in bilateral hemisphere (61.0%), predominantly periventricle (41.9%), basal ganglia (26.1%), and internal capsule for mild CAS (16.8%). Ipsilateral brain lesions were significantly associated with severe CAS (20.9% versus 10.8% for non-ipsilateral brain lesion, p=0.042) and stroke (45.9% versus 24.0% in non-hemispheric symptoms, p=0.035). Non-ipsilateral brain lesions were significantly associated with mild CAS (49.6% versus 40.7% for ipsilateral brain lesion, p=0.042) and non-hemispheric symptoms (72.0% versus 50.3% in stroke, p=0.035). Conclusions: Brain MRI abnormalities were very prevalent in CAS. There were no specific markers of brain MRI abnormalities associated with CAS. Brain abnormalities had been found since mild CAS, which presented in bilateral hemisphere as non-hemispheric symptoms. This study underlines the importance for the assessment of CAS in subjects since non-hemispheric symptoms with brain ischemic-related pathologies.