Open Access Study protocol

The population-based Barcelona-Asymptomatic Intracranial Atherosclerosis Study (ASIA): rationale and design

Elena López-Cancio1*, Laura Dorado1, Mónica Millán1, Silvia Reverté1, Anna Suñol1, Anna Massuet2, María Mataró3, Amparo Galán4, Maite Alzamora5, Guillem Pera5, Pere Torán5, Antoni Dávalos1 and Juan F Arenillas6

Author Affiliations

1 Department of Neurosciences, Hospital Universitari Germans Trias I Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain

2 Magnetic Resonance Unit, Hospital Universitari Germans Trias I Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain

3 Department of Psychiatry and Clinical Psychobiology, Universitat de Barcelona, Barcelona (Spain

4 Department of Biochemistry, Hospital Universitari Germans Trias I Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain

5 Primary Healthcare Research Support Unit Metropolitana Nord, ICS-IDIAP Jordi Gol, Mataró, Barcelona, Spain

6 Neurology Service, Stroke Unit, Hospital Clínico Universitario, Valladolid, Spain

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BMC Neurology 2011, 11:22  doi:10.1186/1471-2377-11-22

Published: 17 February 2011

Abstract

Background

Large-artery intracranial atherosclerosis may be the most frequent cause of ischemic stroke worldwide. Traditional approaches have attempted to target the disease when it is already symptomatic. However, early detection of intracranial atherosclerosis may allow therapeutic intervention while the disease is still asymptomatic. The prevalence and natural history of asymptomatic intracranial atherosclerosis in Caucasians remain unclear. The aims of the Barcelona-ASymptomatic Intracranial Atherosclerosis (ASIA) study are (1) to determine the prevalence of ASIA in a moderate-high vascular risk population, (2) to study its prognostic impact on the risk of suffering future major ischemic events, and (3) to identify predictors of the development, progression and clinical expression of this condition.

Methods/Design

Cross-over and cohort, population-based study. A randomly selected representative sample of 1,503 subjects with a mild-moderate-high vascular risk (as defined by a REGICOR score ≥ 5%) and with neither a history of cerebrovascular nor ischemic heart disease will be studied. At baseline, all individuals will undergo extracranial and transcranial Color-Coded Duplex (TCCD) ultrasound examinations to detect presence and severity of extra and intracranial atherosclerosis. Intracranial stenoses will be assessed by magnetic resonance angiography (MRA). Clinical and demographic variables will be recorded and blood samples will be drawn to investigate clinical, biological and genetic factors associated with the presence of ASIA. A long-term clinical and sonographic follow-up will be conducted thereafter to identify predictors of disease progression and of incident vascular events.

Discussion

The Barcelona-ASIA is a population-based study aiming to evaluate the prevalence and clinical importance of asymptomatic intracranial large-artery atherosclerosis in Caucasians. The ASIA project may provide a unique scientific resource to better understand the dynamics of intracranial atherosclerosis from its early stages and to identify new potential therapeutic targets for this condition.