Deep subcortical infarct burden in relation to apolipoprotein B / AI ratio in patients with intracranial atherosclerotic stenosis

Background and purpose Pre‐existing brain infarct ( PBI ), frequently seen on magnetic resonance imaging and usually silent, is recognized as a risk factor for future stroke. Increased apolipoprotein B (apo B )/apo AI ratio is known to be a risk predictor of ischaemic stroke and is associated with intracranial atherosclerotic stenosis ( ICAS ). However, little is known about the association of apo B /apo AI ratio with PBI . Methods A total of 522 statin‐/fibrate‐naïve K orean patients, who experienced acute ischaemic stroke, were categorized into three groups: ICAS ( n  = 254), extracranial ( n  = 51), and no cerebral atherosclerotic stenosis ( n  = 217). We explored the association between apo B /apo AI ratio and PBI lesions according to atherosclerosis type ( ICAS , ECAS , and NCAS ), PBI location (deep subcortical [ds‐ PBI ] versus hemispheric [h‐ PBI ]), and symptomatic PBI (s‐ PBI ) which was relevant to a prior clinical stroke event. Results Pre‐existing brain infarct(+) patients showed a higher apo B /apo AI ratio than PBI (−) patients (0.81 ± 0.28 vs. 0.72 ± 0.23, P  <   0.001). In ICAS group, patients with higher apo B /apo AI ratio quartiles had more PBI s, ds‐ PBI s, and s‐ PBI s ( P  =   0.020, P  =   0.025, and P  =   0.001, respectively). With multivariable analyses, the highest apo B /apo AI ratio quartile was associated with PBI ( OR , 2.56; 95% CI , 1.39–4.73), ds‐ PBI (2.48; 1.33–4.62), and advanced (≥3) ds‐ PBI s (2.68; 1.27–5.63) in ICAS group, but not with h‐ PBI . s‐ PBI had a dose–response relationship with apo B /apo AI ratio quartiles (6.18; 1.31–29.13 for the second; 5.34; 1.06–26.83 for the third; and 12.17; 2.50–59.19 for the fourth quartile), when referenced to the first quartile. Conclusion Apo B /apo AI ratio is associated with asymptomatic deep subcortical ischaemic burden as well as with symptomatic lesion in patients with ICAS .