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 Kamal, Aga Khan University
Fawad Taj, Aga Khan University
Babar Junaidi, Aga Khan University
Asif Rasheed, Aga Khan University
Moazzam Zaidi, Aga Khan University
Muhammed Murtaza, Aga Khan University
Naved Iqbal, Aga Khan University
Fahad Hashmat, Aga Khan University
Syed Vaqas Alam, Aga Khan University
Uzma Saleem, Aga Khan University
Shahan Waheed, Aga Khan University
Lajpat Bansari, Aga Khan University
Nabi Shah, Aga Khan University
Maria Samuel, Aga Khan University
Madiha Yameen, Aga Khan University
Sobia Naz, Aga Khan University
Farrukh Shahab Khan, Liaquat National Hospital
Naveeduddin Ahmed, Liaquat National Hospital
Khalid Mahmood, Dow University of Health Sciences
Niaz Sheikh, Dow University of Health Sciences
Karim Ullah Makki, Dow University of Health Sciences
Muhammad Masroor Ahmed, Dow University of Health Sciences
Mohammad Wasay, Aga Khan University
Nadir Ali Syed, Aga Khan University
Bhojo A Khealani, Aga Khan University
Philippe M. Frossard, Aga Khan University
Danish Saleheen, Aga Khan University



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.