Atherosclerosis Burden of Brain‐ and Heart‐Supplying Arteries and the Relationship With Vascular Risk in Patients With Ischemic Stroke

BACKGROUND: Atherosclerosis of brain‐ and heart‐supplying arteries (BHAs) are risk indicators for patients with ischemic stroke, but the atherosclerosis burden (AB) of intracranial, cervical, aortic, and coronary arteries in each and in total have not been simultaneously evaluated, and the associations with vascular risk remain unknown. METHODS AND RESULTS: With computed tomography angiography, single‐territory AB was triple ranked on the basis of the number of arterial segments with a significant atherosclerotic lesion. The total AB (TAB) of BHAs was triple ranked on the basis of the number of arterial territories with a significant atherosclerotic lesion, or according to the sum of 4 single‐territory AB rank‐scores. After a 12‐month follow‐up of 395 patients with ischemic stroke, a composite outcome of ischemic stroke, myocardial infarction, and vascular death occurred in 10.9%. The single‐territory AB of intracranial, cervical, aortic, and coronary arteries showed distinct strata patterns and different associations with vascular risk. The score‐based TAB of BHAs predicted vascular risk (crude hazard ratios [95% CIs]: per level increase, 2.35 [1.54–3.58]; median versus low, 3.37 [1.45–7.82]; high versus low, 6.00 [2.36–15.24]) independently of vascular risk factors and single‐territory AB, providing more prognostic information than the TAB of BHAs measured by the number of significantly atherosclerotic territories. Vascular events occurred in 3.0%, 13.6%, and 22.6% of patients in the low (41.8%), median (44.8%), and high (13.4%) strata of the score‐based TAB of BHAs, respectively. CONCLUSIONS: The single‐territory AB of intracranial, cervical, aortic, or coronary arteries might be not reliable for vascular risk stratification in patients with ischemic stroke, and evaluating the TAB of BHAs by quantitatively integrating the single‐territory AB is advisable.