RACE AND SEX-DIFFERENCES IN THE DISTRIBUTION OF CEREBRAL ATHEROSCLEROSIS

Background and Purpose The purpose of this study was to assess the inf luence of race, sex, and other risk factors on the location of atheros clerotic occlusive lesions in cerebral vessels. Previous angiographic studies of patients with stroke or transient ischemic attack (TIA) sug gest that extracranial atherosclerosis is more common in whites and in tracranial disease is more common in blacks. Noninvasive techniques su ch as duplex ultrasound, transcranial Doppler (TCD), and magnetic reso nance angiography (MRA) allow vascular assessment of a more representa tive proportion of patients than does conventional angiography alone. Methods Consecutive patients evaluated at a community hospital for str oke or TIA over a 2-year period were reviewed. Lesions were defined as a 50% or greater atherosclerotic stenosis by angiography, duplex ultr asound, or TCD, or a moderate stenosis by MRA. Results Whites were mor e likely than blacks to have extracranial carotid artery lesions (33% versus 15%, P = .001), but the proportion of patients with intracrania l lesions was similar (24% versus 22%). Men were more likely to have i ntracranial lesions than women (29% versus 14%, P = .03). When multiva riate logistic regression analysis was used, white race was the only p redictor for extracranial carotid artery lesions, and male sex was the only predictor for intracranial lesions. The cause of stroke/TIA was extracranial carotid artery disease in 8% and intracranial disease in 8% of all patients in the study. Conclusions The distribution of cereb ral atherosclerosis is influenced by race and sex but not by other vas cular risk factors. In our patient population, intracranial disease is as common a cause of cerebral ischemia as extracranial carotid diseas e.