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<jats:sec><jats:title>Background</jats:title><jats:p>Intracranial arterial stenosis (ICAS) is an important cause of stroke worldwide. Separate reports in Caucasians and Asians with stroke/transient ischaemic attack (TIA) have suggested lower ICAS prevalence in Caucasians, but there has been no direct comparisons of the two ethnic groups with the same criteria to define ICAS.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Acute minor stroke or TIA patients in two cohorts respectively recruiting patients in Oxford (2011–2018, predominantly Caucasians) and Hong Kong (2011–2015, predominantly Chinese) were compared. ICAS was defined as ≥50% stenosis/occlusion in any major intracranial artery in MR/CT angiography. Prevalence, distribution and risk factors of ICAS were compared between the two cohorts. We also systematically reviewed literature on ICAS prevalence in stroke/TIA patients in different populations.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Among 1287 patients from Oxford and 691 from Hong Kong (mean age 69 vs 66), ICAS prevalence was higher in Chinese than in Caucasians (43.0% vs 20.0%; OR 3.02; 95% CI 2.47 to 3.70; p&lt;0.001), independent of age (age-adjusted OR 3.73; 95% CI 3.00 to 4.63; p&lt;0.001) and vascular risk factors (multivariable-adjusted OR 3.21; 95% CI 2.56 to 4.02; p&lt;0.001). This ethnic difference was greater (p interaction=0.005) at age &lt;70 years (OR 5.33; 95% CI 3.79 to 7.50; p&lt;0.001) than at ≥70 years (OR 2.81; 95% CI 2.11 to 3.74; p&lt;0.001). ICAS prevalence increased with age and with vascular risk factors in both cohorts, with equivalent prevalence in Chinese aged &lt;60 years and Caucasians aged ≥80, and in Chinese with no vascular risk factor and Caucasians with two vascular risk factors. ICAS locations also differed between Chinese and Caucasian patients.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Chinese are more susceptible to ICAS than Caucasians, with an earlier onset age and a higher prevalence, independent of vascular risk factors.</jats:p></jats:sec>

Original publication

DOI

10.1136/jnnp-2020-325630

Type

Journal article

Journal

Journal of Neurology, Neurosurgery & Psychiatry

Publisher

BMJ

Publication Date

30/03/2021