Association of long-term alcohol consumption with DSA-defined concurrent intracranial and extracranial steno-occlusive involvement in acute ischemic stroke.
Jiang L, Wu W, et al. • Frontiers in neurology • 2026
Long-term alcohol consumption remained associated with concurrent intracranial and extracranial steno-occlusive involvement after multivariable adjustment, reflecting a cross-compartment anatomical distribution pattern rather than overall atherosclerotic burden or stenosis severity.
Key Findings
Results
Among acute ischemic stroke patients undergoing DSA, 50.6% had concurrent intracranial and extracranial steno-occlusive involvement.
The retrospective study included 249 patients with acute ischemic stroke presenting within 7 days of symptom onset.
All patients underwent cervicocerebral digital subtraction angiography (DSA) at Huishui People's Hospital, Guizhou, China, from January 2024 to March 2026.
Concurrent involvement was defined as at least one intracranial and at least one extracranial atherosclerotic steno-occlusive lesion in the same patient.
126 of 249 patients (50.6%) met criteria for concurrent involvement.
Results
Long-term alcohol consumption was present in 23.7% of the study cohort and its prevalence varied significantly across steno-occlusive involvement patterns.
59 of 249 patients (23.7%) had long-term alcohol consumption, defined as drinking on at least 3 days per week for at least 5 years before the index stroke.
The prevalence of long-term alcohol consumption was 11.8% in patients with isolated intracranial involvement.
The prevalence was 19.1% in those with isolated extracranial involvement.
The prevalence was 32.5% in those with concurrent involvement.
The difference in prevalence across the three groups was statistically significant (p = 0.003).
Results
After multivariable adjustment, long-term alcohol consumption remained independently associated with concurrent intracranial and extracranial steno-occlusive involvement.
The main multivariable logistic regression model adjusted for long-term alcohol consumption, age, sex, hypertension, diabetes mellitus, and smoking.
Long-term alcohol consumption was associated with concurrent involvement with an adjusted OR of 2.57 (95% CI 1.21–5.50; p = 0.015).
The reference group for this analysis was patients without concurrent involvement (i.e., isolated intracranial or isolated extracranial involvement combined).
Results
Compared with isolated intracranial involvement specifically, long-term alcohol consumption was associated with significantly higher odds of concurrent involvement.
Adjusted OR for concurrent involvement versus isolated intracranial involvement was 2.73 (95% CI 1.09–6.79; p = 0.031).
A similar magnitude of association was observed when isolated extracranial involvement was used as the comparator (adjusted OR 2.64, 95% CI 0.94–7.46; p = 0.066), but this did not reach statistical significance.
The authors note this pattern reflects a cross-compartment anatomical distribution rather than overall atherosclerotic burden or stenosis severity.
Discussion
The study was a retrospective, single-center, DSA-selected cohort, which limits generalizability of the findings.
The study was conducted at a single center (Huishui People's Hospital, Guizhou, China).
The retrospective design and selection of patients who underwent DSA may introduce selection bias.
The authors explicitly state findings 'should be interpreted cautiously and confirmed in larger prospective multicenter studies.'
Long-term alcohol consumption was defined by a specific operational threshold (at least 3 days per week for at least 5 years), which may not capture all relevant drinking patterns.
What This Means
This research suggests that long-term heavy alcohol use may be linked to a specific pattern of artery disease in stroke patients — one where both the blood vessels inside the brain (intracranial) and those in the neck leading to the brain (extracranial) are narrowed or blocked at the same time. Among 249 stroke patients in China who had detailed artery imaging performed, about half had this 'concurrent' pattern of artery disease, and those who drank regularly for many years were roughly 2.5 times more likely to have this combined pattern compared to those who did not drink long-term, even after accounting for other stroke risk factors like high blood pressure, diabetes, and smoking.
Importantly, this association appeared to reflect where the arterial damage occurred — across both compartments simultaneously — rather than simply indicating that alcohol users had more severe or widespread artery disease overall. Patients with long-term alcohol use were especially more likely to have concurrent involvement compared to those with disease only in the brain's arteries, while the comparison to those with disease only in the neck arteries showed a similar trend that did not reach statistical significance.
This research suggests that long-term alcohol consumption may influence how atherosclerosis (artery-hardening disease) is distributed across different vascular regions in stroke patients, potentially through mechanisms that affect both intracranial and extracranial arteries simultaneously. However, because this was a single-hospital, retrospective study of patients selected for a specific imaging procedure, the findings need to be confirmed in larger, prospective studies before broader conclusions can be drawn.
Jiang L, Wu W, Kong L, Xiong J, Zhang X, Wang W, et al.. (2026). Association of long-term alcohol consumption with DSA-defined concurrent intracranial and extracranial steno-occlusive involvement in acute ischemic stroke.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1881608