Elevated plasma level of homocysteine is associated with intra/extracranial atherosclerotic stenosis in Chinese patients with large artery atherosclerotic cerebral infarction

Background and aims Hyperhomocysteinemia was recognized as a risk factor for cerebral infarction, especially caused by large-artery atherosclerosis (LAA). But whether high plasma total homocysteine (tHcy) is associated with cervico-cerebral atherosclerotic stenosis (CCAS) remains unclear. The aim of this study is to investigate whether elevated plasma tHcy is a risk factor for CCAS, and identify its effects on the distribution of CCAS in cerebral infarction. Methods: 123 Chinese patients with LAA cerebral infarction were enrolled. Digital subtraction angiography of cervico-cerebral arteries was performed, and plasma tHcy was assessed in all patients. According to the severity of stenosis, the patients were categorized into CCAS and non CCAS (NCCAS). CCAS was furthered classified into intracranial AS (ICAS), extracranial AS (ECAS) and combined intraand extra-cranial AS (IECAS) subgroups. Results: The concentrations of plasma tHcy were elevated in the patients with CCAS, compared to in NCCAS. After adjusting for other possible confounders, elevated level of plasma tHcy remained an independent risk factor for CCAS (adjusted OR: 1.159). OR of developing CCAS was 3.715 times higher in the highest tHcy quartile, compared to the lowest one. The level of plasma tHcy in the patients with ICAS was higher than that in ECAS. After adjusting for diabetes mellitus, high tHcy remained an independent risk factor for ICAS (adjusted OR: 1.127). Conclusions: The data demonstrate that hyperhomocysteinemia is an independent risk factor for CCAS, and evaluated level of plasma tHcy may contribute to the distribution of CCAS in Chinese patients with LAA cerebral infarction.