CTA Quantification of Intracranial and Extracranial Vascular Narrowing in Patients with Ischemic Stroke Fails to Show Differences Between Patients with Drug Use and Patients Without Drug Use

Download or read book CTA Quantification of Intracranial and Extracranial Vascular Narrowing in Patients with Ischemic Stroke Fails to Show Differences Between Patients with Drug Use and Patients Without Drug Use written by Amanda L Jagolino-Cole and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Purpose:It has been reported that illicit drug use and abuse increases the risk for stroke, both hemorrhagic and ischemic. Marijuana is the most commonly used illicit drug in the United States. Studies have shown that marijuana can affect cerebral auto regulation and vascular tone, leading to reversiblevasoconstriction syndrome. Cocaine use can lead to intracranial hemorrhage and can induce vasoconstriction, vasculitis, vasospasm, or directly affect hemostasis.CTA of the head and neck is routinely used in the care of stroke patients, not only to search for potentially treatable large vessel occlusion, but also to determine the etiology of the stroke.We hypothesized that CTA can show vascular changes in the intracranial and extracranial circulation that may help elucidate the role of marijuana and cocaine in stroke.Materials and Methods:We conducted an IRB approved retrospective review of patients who were admitted for stroke from 2005 to 2015 who had either a positive urine toxicology screen and/or reported drug use (marijuana and/or cocaine) in their medical histories. A control group of patients without drug use wasmatched for the following stroke risk factors: [1] age difference is at most 5 years, [2] type II diabetes, [3] hypertension, [4] elevated cholesterol, and [5] smoking status.Two neuroradiologists blindly interpreted the CTA of the both groups using a previously validated scale which provides an individual and cumulative quantification of the narrowing with or without calcification of the intracranial and extra cranial carotid and vertebrobasilar systems.Results:The case group consisted of 87 patients with a median age of 54 (range 19-72) and the control group of 87 patients with a median age of 56 (range 24-73). The incidence of stroke risk factors was the same for both groups: DM 20.7%, Elevated cholesterol 26.4%, Hypertension 78.2% and Smokinghistory 54%.Our analysis did not find statistically significant differences in the extent of vascular narrowing in the intracranial or extracranial vessels in the patients with drug use as compared to the patients without it, when matched for other risk factors for stroke.Conclusions:CTA failed to identify quantifiable differences in the extent of vascular narrowing with or without atherosclerosis in the intracranial or extracranial vessels in patients with stroke and drug use compared to stroke patients without drug use when matched for multiple risk factors for stroke andvasculopathy.