Risk factors for cerebral artery stenosis in patients with minor ischemic stroke classified as large atherosclerosis

Introduction:
The incidence of minor ischemic stroke (MIS) and associated cognitive impairment is rising, particularly among younger individuals. Thus, both primary and secondary prevention strategies are essential.

Aim:
This study investigated the risk factors for cerebral artery stenosis (CAS) in patients with MIS classified as large atherosclerosis (LAA) by TOAST, and examined the relationship between cognitive function and plasma lipoprotein-associated phospholipase A2 levels.

Material and methods:
We conducted a retrospective analysis of 789 MIS patients admitted to two hospitals between January 2015 and December 2023. Patients were classified using the TOAST criteria, with vascular stenosis detected via computed tomography angiography (CTA) and magnetic resonance angiography (MRA). Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Univariate and multivariate regression analyses were performed to identify risk factors for CAS among LAA-type MIS patients.

Results:
Among the 789 patients, 494 (62.61%) had LAA. A total of 377 (76.32%) patients exhibited LAA-type vascular stenosis. Significant risk factors for CAS included a history of hypertension, diabetes, ischemic stroke, elevated fasting blood glucose, and plasma lipoprotein-associated phospholipase 2 levels (p < 0.05). Multivariate analysis revealed hypertension and increased phospholipase A2 as independent risk factors (OR = 2.046, OR = 1.059). The area under the ROC curve for plasma lipoprotein-associated phospholipase A2 predicting CAS was 0.700 (p < 0.0001). Additionally, a negative correlation was found between plasma lipoprotein-associated phospholipase A2 levels and MMSE scores (r = –0.218, p < 0.001).

Conclusions:
LAA is the predominant cause of MIS, with high rates of vascular stenosis. Hypertension and elevated plasma lipoprotein-associated phospholipase A2 levels are significant independent risk factors for CAS, and increased plasma lipoprotein-associated phospholipase A2 correlates negatively with cognitive function.