Association of long-term alcohol consumption with DSA-defined concurrent intracranial and extracranial steno-occlusive involvement in acute ischemic stroke.

BACKGROUND: Intracranial and extracranial arteries differ in vascular wall structure and susceptibility to atherosclerosis. However, some patients with acute ischemic stroke have steno-occlusive lesions in both arterial compartments. The factors associated with this cross-compartment distribution remain unclear. We examined whether long-term alcohol consumption was associated with digital subtraction angiography (DSA)-defined concurrent intracranial and extracranial involvement. METHODS: This retrospective study included patients with acute ischemic stroke who presented within 7 days of symptom onset and underwent cervicocerebral DSA at Huishui People's Hospital, Guizhou, China, from January 2024 to March 2026. Long-term alcohol consumption was defined as drinking on at least 3 days per week for at least 5 years before the index stroke. Concurrent involvement was defined as at least one intracranial and at least one extracranial atherosclerotic steno-occlusive lesion in the same patient. The main multivariable logistic regression model included long-term alcohol consumption, age, sex, hypertension, diabetes mellitus, and smoking. RESULTS: Among 249 patients, 59 (23.7%) had long-term alcohol consumption and 126 (50.6%) had concurrent involvement. The prevalence of long-term alcohol consumption was 11.8% in patients with isolated intracranial involvement, 19.1% in those with isolated extracranial involvement, and 32.5% in those with concurrent involvement (p = 0.003). After adjustment, long-term alcohol consumption remained associated with concurrent involvement (adjusted OR 2.57, 95% CI 1.21-5.50; p = 0.015). Compared with isolated intracranial involvement, long-term alcohol consumption was associated with higher odds of concurrent involvement (adjusted OR 2.73, 95% CI 1.09-6.79; p = 0.031). A similar but nonsignificant estimate was observed when isolated extracranial involvement was the comparator (adjusted OR 2.64, 95% CI 0.94-7.46; p = 0.066). CONCLUSION: In this DSA-selected cohort, long-term alcohol consumption remained associated with concurrent intracranial and extracranial steno-occlusive involvement after multivariable adjustment. This finding reflects a cross-compartment anatomical distribution pattern rather than overall atherosclerotic burden or stenosis severity. Given the retrospective single-center design, the findings should be interpreted cautiously and confirmed in larger prospective multicenter studies.