Association of plaque enhancement on vessel wall MRI and the phosphodiesterase 4D variant with stroke recurrence in patients with symptomatic intracranial atherosclerosis

Association between PDE4D rs966221 and the Risk of Ischemic Stroke in Regional Chinese Populations

“…In the pathogenesis of IS, PDE4D can inhibit the proliferation and migration of vascular smooth muscle cells to cause arteriosclerosis [41]. Xu's team used magnetic resonance imaging of the vessel wall to confirm that the variants of PDE4D rs966221 were significantly associated with IS recurrence in patients with intracranial atherosclerosis [42]. In IS, the inhibition of PDE4 has further been proven to suppress the immune response in the brain [11].…”

Refined imaging features of culprit plaques improve the prediction of recurrence in intracranial atherosclerotic stroke within the middle cerebral artery territory

“…The inclusion criteria for patient enrollment were as follows: (1) first onset of stroke within 4 weeks of HR-MR-VWI ( Ran et al, 2020 , Jiang et al, 2022 ); (2) acute IS within the unilateral MCA territory as observed on diffusion-weighted imaging (DWI); (3) presence of at least one cardiovascular disease risk factor: hypertension, diabetes mellitus, hyperlipidemia, hyperhomocysteinemia, smoking and/or drinking habits ( Song et al, 2020 , Jiang et al, 2022 ); (4) age of 18 years or older. The exclusion criteria were as follows: (1) presence of chronic IS or transient ischemic attack (TIA); (2) culprit vessel other than the ipsilateral MCA; (3) ipsilateral carotid artery stenosis ≥ 50% ( Song et al, 2020 , Xu et al, 2022 ); (4) patients with infarcts in multiple artery territories beyond MCA ( Li et al, 2021 ). (5) stroke due to other causes, such as arteritis, moyamoya disease, or cerebral artery dissection ( Xu et al 2022 ), embolic stroke of undetermined source (ESUS), cryptogenic strokes ( Wang et al 2022 ); (6) presence of risk factors for cardiogenic stroke, including patent foramen ovale, atrial fibrillation, acute myocardial infarction, cardiomyopathy, and valvular heart disease ( Liu et al, 2022 , Yang et al, 2022 ); (7) poor quality of HR-MR-VWI imaging or inadequate clinical information.…”

“…The exclusion criteria were as follows: (1) presence of chronic IS or transient ischemic attack (TIA); (2) culprit vessel other than the ipsilateral MCA; (3) ipsilateral carotid artery stenosis ≥ 50% ( Song et al, 2020 , Xu et al, 2022 ); (4) patients with infarcts in multiple artery territories beyond MCA ( Li et al, 2021 ). (5) stroke due to other causes, such as arteritis, moyamoya disease, or cerebral artery dissection ( Xu et al 2022 ), embolic stroke of undetermined source (ESUS), cryptogenic strokes ( Wang et al 2022 ); (6) presence of risk factors for cardiogenic stroke, including patent foramen ovale, atrial fibrillation, acute myocardial infarction, cardiomyopathy, and valvular heart disease ( Liu et al, 2022 , Yang et al, 2022 ); (7) poor quality of HR-MR-VWI imaging or inadequate clinical information.…”

“…The high recurrence rate (10–24%) of ICAS stroke contributes to unfavorable outcomes among IS patients ( Ran et al, 2020 ). Despite active treatment strategies aimed at mitigating vascular risk factors and implementing intensive antiplatelet therapy, the annual recurrence rate of ICAS stroke remains alarmingly high at 14.9% ( Xu et al 2022 ). Previous studies have indicated that the elevated recurrence rate of ICAS stroke within the MCA territory could be attributed to plaque rupture, plaque progression in the culprit vessel, and insufficient collateral circulation resulting from perforating vessel disease ( Zhao et al, 2016 , Song et al, 2020 , Yang et al, 2022 ).…”