This paper investigates evidence indicating that intracranial carotid artery atherosclerosis may develop under the influence of a differential metabolic risk factor profile, rather than atherosclerosis in the extracranial part of the carotid artery.

Vojinovica and colleagues, investigated metabolic associations with intracranial and extracranial carotid artery atherosclerosis in 1,111 participants from the population-based Rotterdam Study. Results found that a higher circulating level of 3-hydroxybutyrate was associated with an increase in intracranial carotid artery calcification and there were distinct differences in metabolic association patterns of extra- and intracranial carotid artery calcification, providing further evidence for location-specific differences in the etiology of atherosclerosis.