Introduction
Atherosclerosis is the primary driver of cardiovascular disease, which,
according to the World Health Organization (WHO), makes up 31% - nearly
18 million- of deaths worldwide.1 Importantly, the
progressive nature of the disease means that through early detection, we
can prevent arterial blockage and consequent ischemia. Early affection
of the coronary arteries can be gauged using coronary artery
calcification (CAC), and since atherosclerosis is a systemic disease,
the affection of the coronaries could imply affection of other arteries,
such as the cerebral or peripheral arteries.2–4
In accordance with the above, several studies have reported a higher
prevalence of coronary artery disease (CAD) in patients with symptomatic
cerebrovascular disease (CVD), as both entities share a common
underlying pathophysiological mechanism of endothelial dysfunction due
to atherosclerotic disease.5
Stroke is a major cause of global morbidity and mortality, and despite a
decrease in mortality over the last two decades, the incidence of
stroke, as well as stroke-related deaths and disabilities, have
increased, with low and middle-income countries bearing much of the
brunt.6 The most common cause of cerebral ischemia is
the atherosclerotic narrowing of cerebral blood vessels. Other causes
include extra-cranial emboli, typically originating from the heart, and
cerebral venous thromboses. Since atherothrombosis represents the most
common cause of stroke,7 it is vital to investigate
the utility of early markers of atherosclerosis, such as CAC, as
predictors of stroke.
Early in the 1980s, CAC was first detected after the development of
electron beam computed tomographic scanning (EBCT), which permitted
noninvasive and quantitative detection of CAC.8Afterward, the development of multi-detector computed tomography (MDCT)
leads to a significant improvement in the direct visualization of
coronary arteries and the development of CAC scoring. CAC scoring aims
to measure and detect the amount of calcium in the wall of the coronary
arteries. It can be presented through the Agatston score or the
traditional CAC score, detected on CT angiography
CTA.9–11 Nowadays, the Agatston score is the
routinely used scoring for CAC quantification.8
CAC scoring has proven a useful tool in both the detection and
prognostication of significant CAD, as studies have demonstrated a high
degree of sensitivity in ruling out significant coronary stenosis, and
reduced survival in those with higher calcium
scores.12,13 As previously mentioned, atherosclerosis
is a systemic disease, and it is precisely this systemic nature that may
allow us to extend the usage of CAC from the prevention of the coronary
manifestations of atherosclerosis, namely CAD, to the prevention of
cerebrovascular manifestations, namely CVA. The aim of this review is to
determine the role of CAC scoring in the detection of CVA.