Open Access Study protocol

The Karachi intracranial stenosis study (KISS) Protocol: An urban multicenter case-control investigation reporting the clinical, radiologic and biochemical associations of intracranial stenosis in Pakistan

Ayeesha Kamran Kamal1*, Fawad Taj1, Babar Junaidi1, Asif Rasheed1, Moazzam Zaidi1, Muhammed Murtaza1, Naved Iqbal1, Fahad Hashmat1, Syed Vaqas Alam1, Uzma Saleem1, Shahan Waheed1, Lajpat Bansari1, Nabi Shah1, Maria Samuel1, Madiha Yameen1, Sobia Naz1, Farrukh Shahab Khan2, Naveeduddin Ahmed2, Khalid Mahmood3, Niaz Sheikh3, Karim Ullah Makki3, Muhammad Masroor Ahmed3, Abdul Rauf Memon3, Mohammad Wasay1, Nadir Ali Syed1, Bhojo Khealani1, Philippe M Frossard15 and Danish Saleheen145

Author Affiliations

1 Stroke Service, Division of Neurology, Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi-74800, Pakistan

2 Stroke Center, Department of Neurology, Liaquat National Hospital, Institute for Post Graduate Medical Studies and Health Sciences, Stadium Road, Karachi-74800, Pakistan

3 Department Of Medicine, Dow University of Health Sciences, Civil Hospital Karachi, Baba-e-Urdu Road, Karachi, Pakistan

4 Department of Public Health and Primary Care, University of Cambridge, UK

5 Center for Non-Communicable Diseases, Karachi, Pakistan

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BMC Neurology 2009, 9:31  doi:10.1186/1471-2377-9-31

Published: 15 July 2009



Intracranial stenosis is the most common cause of stroke among Asians. It has a poor prognosis with a high rate of recurrence. No effective medical or surgical treatment modality has been developed for the treatment of stroke due to intracranial stenosis. We aim to identify risk factors and biomarkers for intracranial stenosis and to develop techniques such as use of transcranial doppler to help diagnose intracranial stenosis in a cost-effective manner.


The Karachi Intracranial Stenosis Study (KISS) is a prospective, observational, case-control study to describe the clinical features and determine the risk factors of patients with stroke due to intracranial stenosis and compare them to those with stroke due to other etiologies as well as to unaffected individuals. We plan to recruit 200 patients with stroke due to intracranial stenosis and two control groups each of 150 matched individuals. The first set of controls will include patients with ischemic stroke that is due to other atherosclerotic mechanisms specifically lacunar and cardioembolic strokes. The second group will consist of stroke free individuals. Standardized interviews will be conducted to determine demographic, medical, social, and behavioral variables along with baseline medications. Mandatory procedures for inclusion in the study are clinical confirmation of stroke by a healthcare professional within 72 hours of onset, 12 lead electrocardiogram, and neuroimaging. In addition, lipid profile, serum glucose, creatinine and HbA1C will be measured in all participants. Ancillary tests will include carotid ultrasound, transcranial doppler and magnetic resonance or computed tomography angiogram to rule out concurrent carotid disease. Echocardiogram and other additional investigations will be performed at these centers at the discretion of the regional physicians.


The results of this study will help inform locally relevant clinical guidelines and effective public health and individual interventions.