Homocysteine and Internal Carotid Artery Occlusion in Ischemic Stroke

Aim: Homocysteine is associated with increased arterial resistance and eventually causes luminal reduction. The purpose of the present study was to evaluate an association between the plasma concentration of total homocysteine (tHcy) and stenosis or occlusion of the internal carotid artery (ICA) in patients with ischemic stroke. Methods: In total, 391 patients with ischemic stroke were evaluated from March 2007 to February 2008. The criterion for ICA stenosis or occlusion was set at greater than 50% luminal narrowing or complete obstruction in at least one ICA. Patients were assigned to one of three groups: normal ICA, ICA stenosis, and ICA occlusion. Results: ICA stenosis was found in 71 patients, whereas ICA occlusion in 22 patients (18.2% and 5.6%, respectively). Plasma tHcy was significantly higher in groups with ICA stenosis/occlusion with the highest value of ICA occlusion (14.6 +/- 1.0 mu mol/L, p = 0.025). A 1 mu mol/L increase of tHcy showed an adjusted odds ratio of 1.12 (95% confidence intervals, 1.03-1.24, p = 0.008) for ICA occlusion in a multivariate logistic model adjusted for all possible confounders, including age, sex, vascular risk factors, and stroke classifications. Conclusion: Elevated levels of tHcy were significantly associated with the ICA occlusion, independent of vascular risk factors and stroke subtypes.