Abstract：
OBJECTIVE: Evidence for an association between Internal carotid artery (ICA) kinking and ischemic stroke has been controversial. We aimed to examine the association between ICA tortuosity and risk of ischemic stroke and specific ischemic stroke subtypes (large artery atherosclerosis, LAA; small artery occlusion, SAO).
METHODS: A total of 419 outpatients were included in this cross-sectional study. ICA kinking was objectively assessed by head and neck computed tomography angiography (CTA). The risk of ischemic stroke for each patient was evaluated according to the Essen Stroke Risk Score (ESRS). Ischemic stroke subtypes (LAA and SAO) were measure with head magnetic resonance imaging (MRI).
RESULTS: The average age of patients was 59.1 years (SD = 13.25) and 264 (63.0 %) were males. The prevalence of ICA kinking in this sample was 31.5 % (132 out of 419). Individuals with ICA kinking was associated with 0.55-points increase in ESRS score than those without ICA kinking (95 % CI, 0.28-0.81, p < 0.001) among patients over 50 years. In addition, right ICA kinking or left ICA kinking were associated with 0.35-points (95 % CI, 0.08-0.63) and 0.49-points (95 % CI, 0.23-0.76) increase in ESRS score, respectively. For specific ischemic stroke subtypes, individuals with ICA kinking had a 10.34-fold increased risk of SAO compared to those without ICA kinking (95 % CI, 6.22-20.68). Individuals with right ICA kinking had a 4.51-fold risk of SAO than those without kinking (95 % CI, 2.64-7.71), and had an 8.86-fold risk of SAO than those without kinking in the left ICA kinking (95 % CI, 4.97-15.79).
CONCLUSIONS: Our findings support the role of ICA kinking on ischemic stroke. Early screening and proper treatment of carotid artery tortuosity could be a potential intervention strategy for the prevention of ischemic stroke later on.
METHODS: A total of 419 outpatients were included in this cross-sectional study. ICA kinking was objectively assessed by head and neck computed tomography angiography (CTA). The risk of ischemic stroke for each patient was evaluated according to the Essen Stroke Risk Score (ESRS). Ischemic stroke subtypes (LAA and SAO) were measure with head magnetic resonance imaging (MRI).
RESULTS: The average age of patients was 59.1 years (SD = 13.25) and 264 (63.0 %) were males. The prevalence of ICA kinking in this sample was 31.5 % (132 out of 419). Individuals with ICA kinking was associated with 0.55-points increase in ESRS score than those without ICA kinking (95 % CI, 0.28-0.81, p < 0.001) among patients over 50 years. In addition, right ICA kinking or left ICA kinking were associated with 0.35-points (95 % CI, 0.08-0.63) and 0.49-points (95 % CI, 0.23-0.76) increase in ESRS score, respectively. For specific ischemic stroke subtypes, individuals with ICA kinking had a 10.34-fold increased risk of SAO compared to those without ICA kinking (95 % CI, 6.22-20.68). Individuals with right ICA kinking had a 4.51-fold risk of SAO than those without kinking (95 % CI, 2.64-7.71), and had an 8.86-fold risk of SAO than those without kinking in the left ICA kinking (95 % CI, 4.97-15.79).
CONCLUSIONS: Our findings support the role of ICA kinking on ischemic stroke. Early screening and proper treatment of carotid artery tortuosity could be a potential intervention strategy for the prevention of ischemic stroke later on.
摘要：
目的：颈内动脉（ICA）扭结与缺血性卒中之间的关联一直存在争议。我们旨在检查ICA弯曲与缺血性卒中风险和特定缺血性卒中亚型（大动脉粥样硬化，左心耳；小动脉闭塞，SAO）。
方法：本横断面研究共纳入419名门诊患者。通过头颈部计算机断层扫描血管造影（CTA）客观评估ICA扭结。根据Essen卒中风险评分（ESRS）评估每位患者的缺血性卒中风险。用头部磁共振成像（MRI）测量缺血性卒中亚型（LAA和SAO）。
结果：患者的平均年龄为59.1岁（SD=13.25），男性为264（63.0％）。该样本中ICA扭结的患病率为31.5%(419个中的132个)。在50岁以上的患者中，与没有ICA扭结的患者相比，ICA扭结的患者ESRS评分增加0.55分（95％CI，0.28-0.81，p<0.001）。此外,右ICA扭结或左ICA扭结与ESRS评分增加0.35分(95%CI,0.08-0.63)和0.49分(95%CI,0.23-0.76)相关,分别。对于特定的缺血性卒中亚型，与无ICA扭结者相比,有ICA扭结者的SAO风险增加10.34倍(95%CI,6.22~20.68).具有正确ICA扭结的个体的SAO风险是没有扭结的个体的4.51倍（95％CI，2.64-7.71），并且在左侧ICA扭结中没有扭结的SAO风险为8.86倍（95％CI，4.97-15.79）。
结论：我们的研究结果支持ICA扭结在缺血性卒中中的作用。早期筛查和正确治疗颈动脉弯曲可能是预防缺血性卒中的潜在干预策略。
方法：本横断面研究共纳入419名门诊患者。通过头颈部计算机断层扫描血管造影（CTA）客观评估ICA扭结。根据Essen卒中风险评分（ESRS）评估每位患者的缺血性卒中风险。用头部磁共振成像（MRI）测量缺血性卒中亚型（LAA和SAO）。
结果：患者的平均年龄为59.1岁（SD=13.25），男性为264（63.0％）。该样本中ICA扭结的患病率为31.5%(419个中的132个)。在50岁以上的患者中，与没有ICA扭结的患者相比，ICA扭结的患者ESRS评分增加0.55分（95％CI，0.28-0.81，p<0.001）。此外,右ICA扭结或左ICA扭结与ESRS评分增加0.35分(95%CI,0.08-0.63)和0.49分(95%CI,0.23-0.76)相关,分别。对于特定的缺血性卒中亚型，与无ICA扭结者相比,有ICA扭结者的SAO风险增加10.34倍(95%CI,6.22~20.68).具有正确ICA扭结的个体的SAO风险是没有扭结的个体的4.51倍（95％CI，2.64-7.71），并且在左侧ICA扭结中没有扭结的SAO风险为8.86倍（95％CI，4.97-15.79）。
结论：我们的研究结果支持ICA扭结在缺血性卒中中的作用。早期筛查和正确治疗颈动脉弯曲可能是预防缺血性卒中的潜在干预策略。
