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.