Background: Intracranial stenosis in young patients appears to have different characteristics from that observed in the older population. Objective: To study the differences in the pathogenesis of intracranial stenosis in younger patients as compared to the older population. Methods: The clinical characteristics of patients with angiographically confirmed intracranial stenosis were matched to a healthy population using the National Health and Nutrition Examination Study (NHANES). The study population was stratified into two age groups (≤45 and >45 years). The relative risk (odds ratios) and attributable risk of known cardiovascular risk factors were estimated. Results: A total of 17 (11%) patients from 153 patients with intracranial stenosis were aged ≤45 years. These patients were more likely to be women (53 vs. 28%, p < 0.05). The location of the lesion in the young patients was more likely to be in the internal carotid artery (65 vs. 29%, p < 0.05). When compared with the stroke risk factors from the NHANES control population, the attributable risk of hypertension, diabetes mellitus, and coronary artery disease for intracranial stenosis was lower among patients aged ≤45 years than that for patients aged >45 years (6.4 vs. 13.1%, 19.9 vs. 33.0% and 1.0 vs. 10.8%, respectively). Hyperlipidemia had a greater attributable risk of intracranial stenosis in patients ≤45 than in those >45 years of age (23.3 vs. 9.3%). Conclusions: Intracranial stenosis in young patients is predominantly located in the anterior circulation and more frequently occurs in young women. Even though the stroke risk factors appear to be strongly associated with intracranial stenosis in this age group, the impact of these risk factors is low due to the low prevalence.

Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Trial Investigators: Design, progress and challenges of a double-blind trial of warfarin versus aspirin for symptomatic intracranial arterial stenosis. Neuroepidemiology 2003;22:106–117.
Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries (SSYLVIA): study results. Stroke 2004;35:1388–1392.
Bogousslavsky J, Barnett HJ, Fox AJ, Hachinski VC, Taylor W: Atherosclerotic disease of the middle cerebral artery. Stroke 1986;17:1112–1120.
Chimowitz MI, Kokkinos J, Strong J, et al: The Warfarin-Aspirin Symptomatic Intracranial Disease Study. Neurology 1995;45:1488–1493.
Gomez CR, Orr SC: Angioplasty and stenting for primary treatment of intracranial arterial stenoses. Arch Neurol 2001;58:1687–1690.
Sacco RL, Kargman DE, Gu Q, Zamanillo MC: Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke 1995;26:14–20.
Segura T, Serena J, Castellanos M, Teruel J, Vilar C, Davalos A: Embolism in acute middle cerebral artery stenosis. Neurology 2001;56:497–501.
Wityk RJ, Lehman D, Klag M, Coresh J, Ahn H, Litt B: Race and sex differences in the distribution of cerebral atherosclerosis. Stroke 1996;27:1974–1980.
Baker AB, Resch JA, Loewenson RB: Cerebral atherosclerosis in European populations: a preliminary report. Stroke 1973;4:898–903.
Flora GC, Baker AB, Loewenson RB, Klassen AC: A comparative study of cerebral atherosclerosis in males and females. Circulation 1968;38:859–869.
Turk AS, Levy EI, Albuquerque FC, et al: Influence of patient age and stenosis location on wingspan in-stent restenosis. AJNR Am J Neuroradiol 2008;29:23–27.
Berry JD, Lloyd-Jones DM, Garside DB, Greenland P: Framingham risk score and prediction of coronary heart disease death in young men. Am Heart J 2007;154:80–86.
Ford ES, Giles WH, Mokdad AH: The distribution of 10-Year risk for coronary heart disease among US adults: findings from the National Health and Nutrition Examination Survey III. J Am Coll Cardiol 2004;43:1791–1796.
Sibley C, Blumenthal RS, Merz CN, Mosca L: Limitations of current cardiovascular disease risk assessment strategies in women. J Womens Health (Larchmt) 2006;15:54–56.
Berry JD, Liu K, Folsom AR, et al: Prevalence and progression of subclinical atherosclerosis in younger adults with low short-term but high lifetime estimated risk for cardiovascular disease: the coronary artery risk development in young adults study and multi-ethnic study of atherosclerosis. Circulation 2009;119:382–389.
Turan TN, Makki AA, Tsappidi S, et al: Risk factors associated with severity and location of intracranial arterial stenosis. Stroke 2010;41:1636–1640.
Qureshi AI, Feldmann E, Gomez CR, et al: Consensus conference on intracranial atherosclerotic disease: rationale, methodology, and results. J Neuroimaging 2009;19(suppl 1):1S–10S.
Centers for Disease Control and Prevention (CDC). accessed on Dec. 2010.
Qureshi AI, Suri MF, Yahia AM, et al: Risk factors for subarachnoid hemorrhage. Neurosurgery 2001;49:607–612.
Benichou J: A review of adjusted estimators of attributable risk. Stat Methods Med Res 2001;10:195–216.
Hennekens CH BJ: Epidemiology in Medicine, ed 1. Boston, Little, Brown, 1987.
Groom D, Mc KE, Webb C, et al: Coronary and aortic atherosclerosis in the Negroes of Haiti and the United States. Ann Intern Med 1959;51:270–289.
Larsen NP: Atherosclerosis: an autopsy study. Hawaii Med J 1954;14:129–132.
Levy EI, Turk AS, Albuquerque FC, et al: Wingspan in-stent restenosis and thrombosis: incidence, clinical presentation, and management. Neurosurgery 2007;61:644–650.
Bin Zhang, ShuXiang Pu: Sex differences in risk factors, etiology, and short-term outcome of cerebral infarction in young patients. Atherosclerosis 2011;216:420–425.
Marini C, Russo T, Felzani G: Incidence of stroke in young adults: a review. Stroke Res Treat 2010;2011:535672.
Yamashita M, Oka K, Tanaka K: Histopathology of the brain vascular network in moyamoya disease. Stroke 1983;14:50–58.
Masuda J, Ogata J, Yutani C: Smooth muscle cell proliferation and localization of macrophages and T cells in the occlusive intracranial major arteries in moyamoya disease. Stroke 1993;24:1960–1967.
Fukui M, Kono S, Sueishi K, Ikezaki K: Moyamoya disease. Neuropathology 2000;20(suppl):S61–S64.
Sacco RL, Kargman DE, Gu Q, Zamanillo MC: Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke 1995;26:14–20.
Wityk RJ, Lehman D, Klag M, Coresh J, Ahn H, Litt B: Race and sex differences in the distribution of cerebral atherosclerosis. Stroke 1996;27:1974–1980.
Ohira T, Shahar E, Iso H, Chambless LE, Rosamond WD, Sharrett AR, Folsom AR: Carotid artery wall thickness and risk of stroke subtypes: the atherosclerosis risk in communities study. Stroke 2011;42:397–403.
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