Different risk factors in identical features of intracranial atherosclerosis plaques in the posterior and anterior circulation in high-resolution MRI

Xu, Ziqi; Li, Mingyao; Lyu, Jinhao; Hou, Zhe; He, Jianfeng; Mo, Dapeng; Gao, Feng; Liu, Xin; Sui, Binbin; Shen, Mowei; Pan, Yuesong; Wang, Yongjun; Lou, Xin; Miao, Zhongrong; Luo, Benyan; Ma, Ning

doi:10.1177/1756286420909991

Cited by 13 publications

(14 citation statements)

References 35 publications

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“…Compared with non-diabetic patients, diabetic patients had a signi cantly higher incidence of plaque enhancement, longer maximum plaque length, greater maximum plaque wall thickness, and increased luminal stenosis degree [28][29][30] . Therefore, we speculated that the appearance of the vulnerable characteristics of the posterior circulation culprit plaque might be related to the metabolic factors of secondary diabetes.…”

Section: Discussionmentioning

confidence: 99%

Correlation of The Characteristics of Symptomatic Intracranial Atherosclerotic Plaques with Stroke Types and Risk of Stroke Recurrence

Ren¹,

Jiang²,

Zhu³

et al. 2021

Preprint

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Purpose To explore the relationship of the characteristics of symptomatic intracranial atherosclerotic plaques (ICAP) with stroke types and risk of stroke recurrence. Methods Patients with symptomatic intracranial atherosclerotic stenosis were prospectively enrolled. The vessel stenosis degree, plaque shape, plaque thickness, plaque burden, and plaque enhancement degree of all patients were assessed using high-resolution magnetic resonance imaging and statistically analyzed. Results In total, 206 patients (mean age (64 ± 12) years; 141 males) were included in this study, 154 had acute ischemic stroke (AIS), 52 had transient ischemic attack (TIA), 124 had anterior circulation ischemic symptom (ACIS), and 82 had posterior circulation ischemic symptom (PCIS). AIS patients showed higher diastolic blood pressure (t=-2.605, p = 0.011), total cholesterol (t=-2.470, p = 0.014), apolipoprotein b (z=-2.411, p = 0.016), apolipoprotein a/b (t=-2.865, p = 0.006), LDL (t=-2.424, p = 0.016), arteriosclerosis index (z=-2.256, p = 0.024), stenosis degree (t=-3.317, p < 0.001) but smaller luminal area at the plaque than TIA patients (t = 2.539, p = 0.013). In addition, 24 (13.6%) patients had stroke recurrence within 6 months. The proportion of patients with T1WI hyperintensity was higher in patients with recurrent stroke than in patients without recurrent stroke (RR = 2.592 (1.091, 6.58), χ²=4.892, p = 0.034). Patients with PCIS had greater plaque thickness (t=-4.205, p < 0.001) and remaining luminal area (z=-4.127, p < 0.001), significantly enhanced ICAP (χ²=9.681, p = 0.003), more positive remodeling (χ²=5.661, p = 0.015) and higher incidence of T1WI hyperintensity (χ²=16.472, p < 0.001) than patients with ACIS. The prevalence of diabetes (χ²=9.038, p = 0.004) in patients with PCIS is higher than that in patients with ACIS. Conclusions The degree of stenosis and the remaining luminal area of symptomatic ICAP are related to the type of stroke, and patients with T1WI hyperintense plaque had a higher risk of stroke recurrence within six months. Posterior circulation culprit plaque tends to have higher vulnerability, which may be related to metabolic factors secondary to diabetes.

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Section: Discussionmentioning

confidence: 99%

Correlation of The Characteristics of Symptomatic Intracranial Atherosclerotic Plaques with Stroke Types and Risk of Stroke Recurrence

Ren¹,

Jiang²,

Zhu³

et al. 2021

Preprint

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“…Patients with the following inclusion criteria were included: (1) age ≥18 years old, (2) ischemic stroke in the vertebrobasilar territory as identified by diffusion-weighted imaging (DWI)/T2-weighted imaging (T2WI)/CT, (3) 70–99% stenosis of the intracranial vertebral artery or basilar artery as confirmed by MRA, CTA, or DSA, and (4) two or more atherosclerotic risk factors including hypertension, hyperlipidemia, diabetes mellitus, obesity, and cigarette smoking. The definition of risk factor was the same as the previous protocol ( 22 ). Exclusion criteria were (1) coexistent >50% stenosis of the ipsilateral or bilateral extracranial vertebral artery; (2) evidence of cardio-embolism, such as atrial fibrillation, recent myocardial infarct within 4 weeks, mitral stenosis or prosthetic valve, etc.…”

Section: Methodsmentioning

confidence: 99%

“…Details of the parameters of the HRMRI multiple sequences were the same as the previous studies ( 22 , 25 ). The images were acquired by a coronal or axial view, which covered the intracranial vertebral artery and basilar artery.…”

Section: Methodsmentioning

confidence: 99%

“…T1-weighted vessel wall images of responsible lesions were reconstructed into cross-sectional areas (perpendicular to the vessel longitudinal axis) at the image workstation. The evaluation was subsequently performed on the reformatted images using freely available software ImageJ (Rasband, National Institute of Mental Health, Bethesda, MD, USA) ( 22 ). All images were analyzed by two experienced neuroradiologists (LX and LJH) who were blinded to the clinical data of the patients.…”

Section: Methodsmentioning

confidence: 99%

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Intraplaque Enhancement Is Associated With Artery-to-Artery Embolism in Symptomatic Vertebrobasilar Atherosclerotic Diseases

Hou

Lyu

et al. 2021

Front. Neurol.

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Objective: There are limited data regarding the characteristics of intracranial plaques according to stroke mechanism in the posterior circulation. This study aims to compare whether the plaque characteristics and baseline features are different in patients with artery-to-artery (A-to-A) embolism and those with parent artery disease in the intracranial vertebrobasilar atherosclerotic disease.Methods: From September 2014 to January 2017, patients with recent posterior circulation stroke due to intracranial vertebrobasilar atherosclerotic disease were retrospectively analyzed. Patients with the following eligibility criteria were included: (1) age ≥18 years old, (2) ischemic stroke in the vertebrobasilar territory, (3) 70–99% stenosis of the intracranial vertebral artery or basilar artery, and (4) two or more atherosclerotic risk factors. Patients with concomitant ipsilateral or bilateral extracranial vertebral artery >50% stenosis, cardio-embolism, or non-atherosclerotic stenosis were excluded. The plaque characteristics, including intraplaque compositions (intraplaque hemorrhage and intraplaque calcification), intraplaque enhancement, and remodeling index, were evaluated by using 3T high-resolution magnetic resonance imaging (HRMRI). The baseline features including vascular risk factors and the involved artery were collected. Patients were divided into A-to-A embolism and parent artery disease groups based on the diffusion-weighted images, T2-weighted images, or computed tomography. The plaque characteristics and baseline features were compared between the two groups.Results: Among consecutive 298 patients, 51 patients were included. Twenty-nine patients had A-to-A embolism and 22 patients had parent artery disease. Compared with parent artery disease, the occurrence rates of intraplaque enhancement and intracranial vertebral involvement were higher in the A-to-A embolism group (79.3 vs. 36.4%; p = 0.002 and 62.1 vs. 18.2%; p = 0.002, respectively). Multivariable logistic regression analysis showed that intraplaque enhancement and intracranial vertebral artery plaques were also associated with A-to-A embolism (adjusted OR, 7.31; 95% CI 1.58–33.77; p = 0.011 and adjusted OR, 9.42; 95% CI 1.91–46.50; p = 0.006, respectively).Conclusion: Intraplaque enhancement and intracranial vertebral artery plaques seem to be more closely associated with A-to-A embolism than parent artery disease in patients with symptomatic intracranial vertebrobasilar disease.Clinical Trial Registration:http://www.clinicaltrials.gov, identifier: NCT02705599.

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“…Increased vertebral artery (VA) difference, tortuosity and torsion as well as increased basilar artery (BA) curvature and tortuosity may cause a turbulent blood flow, which plays an important role in the pathogenesis of atherosclerosis [ 3 ]. Furthermore, it has been shown that the posterior circulation is much more susceptible to atherosclerosis in comparison with the anterior circulation [ 4 ]. These vertebrobasilar morphological indices have also been linked to peri-vertebrobasilar infarcts as risk factors and have indicated a directional and locational correlation [ 3 , 5 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Are the Morphological Indices of the Vertebrobasilar System Heritable? A Twin Study Based on 3D Reconstructed Models

et al. 2021

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Background and Objectives: The asymmetrical vertebral artery (VA) flow and diameter are common findings, which can result in an asymmetrical blood flow in the basilar artery (BA), leading to bending of the artery over time. This study investigated whether the variation of the different vertebrobasilar morphological indices that influence flow characteristics might be inherited. Materials and Methods: We analyzed 200 cerebral magnetic resonance imaging (MRI) scans of healthy Caucasian twins (100 pairs) who underwent time-of-flight MRI. From the scans, we reconstructed the 3D mesh of the posterior circulation from the start of the V4 segment to the basilar tip and subsequently analyzed the morphology of the vertebrobasilar system. The phenotypic covariances of the different morphological parameters were decomposed into heritability (A), shared (C), and unshared (E) environmental effects. Results: 39% of the twins had left dominant VA, while 32.5% had right dominant. In addition, 28.5% were classified as equal. The vertebral artery V4 segment diameter, curvature, and tortuosity were mainly influenced by shared (C) and unshared (E) environmental factors. A moderate heritability was found for the BA length (A: 63%; 95% CI: 45.7–75.2%; E: 37%; 95% CI: 24.8–54.3%) and volume (A: 60.1%; 95% CI: 42.4–73.2%; E: 39.9%; 95% CI: 26.8–57.6%), while the torsion of both arteries showed no heritability and were only influenced by the unshared environment. Conclusions: The length and volume of the BA show a moderate genetical influence. However, most of the measured morphological indices were influenced by shared and unshared factors, which highlight the role of the ever-changing hemodynamic influences shaping the geometry of the vertebrobasilar system.

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Different risk factors in identical features of intracranial atherosclerosis plaques in the posterior and anterior circulation in high-resolution MRI

Cited by 13 publications

References 35 publications

Correlation of The Characteristics of Symptomatic Intracranial Atherosclerotic Plaques with Stroke Types and Risk of Stroke Recurrence

Correlation of The Characteristics of Symptomatic Intracranial Atherosclerotic Plaques with Stroke Types and Risk of Stroke Recurrence

Intraplaque Enhancement Is Associated With Artery-to-Artery Embolism in Symptomatic Vertebrobasilar Atherosclerotic Diseases

Are the Morphological Indices of the Vertebrobasilar System Heritable? A Twin Study Based on 3D Reconstructed Models

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