Etiology of intracranial stenosis in young patients: a high-resolution magnetic resonance imaging study

Abstract

Background: Using high-resolution magnetic resonance imaging (HRMRI), we sought to investigate the underlying etiology of intracranial stenosis in young patients. Methods:We retrospectively studied 122 Chinese young adult patients (from 18 to 45 years old, mean age 36.2±7.5 years) with unilateral middle cerebral artery (MCA) stenosis based on a prospectively established HRMRI database. The eccentricity, degree of stenosis, and remodeling types of MCA lesions were analyzed.The MCA lesions were classified as eccentric (presumed atherosclerosis) or concentric stenosis (presumed non-atherosclerosis). The clinical data and vessel wall properties were compared between the patients >35 years old and the patients ≤35 years old.Results: Eccentric stenosis was observed in 98 (80.3%) patients and concentric stenosis in 24 (19.7%) patients. The patients with eccentric stenosis were older (37.5±6.8 vs. 31.4±8.4 years old, P<0.001) and more likely had atherosclerosis risk factors (56.1% vs. 25.0%, P=0.006). The patients >35 years old had higher prevalence (90.1% vs. 66.7%, P=0.001) of eccentric stenosis and atherosclerosis factors (60.6% vs. 35.3%, P=0.006) than the patients ≤35 years old. Most of the patients with concentric stenosis were ≤35 years old (17/24, 70.8%) and were female (16/24, 66.7%). Binary Logistic analysis suggested smoking (OR =3.171; 95% CI,) and remodeling ratio (OR =1.625; 95% CI, 1.001-2.636) were independent predictive factors for symptomatic stenosis.Conclusions: Atherosclerosis is the most common cause of intracranial stenosis in Chinese young patients.Non-atherosclerosis disease is an important etiology in young female, especially in the patients aged 35 years old or younger.

Association of antinuclear antibodies with the risk of intracranial arterial stenosis

“…Studies have found the attributable risk of hypertension, diabetes mellitus, and coronary artery disease for intracranial stenosis was lower among patients aged ≤45 years than that among patients aged >45 years [18]. Non-atherosclerotic disease is an important etiology of intracranial stenosis in young patients [19]. However, in older patients with intracranial stenosis, more metabolic factors such as hyperuricemia are involved [20].…”

Intracranial artery stenosis magnetic resonance imaging aetiology and progression study: Rationale and design

“…In contrast, Xu et al. () recruited 122 Chinese young patients (from 18 to 45 years old) with unilateral middle cerebral artery stenosis to determine the etiology of ICAS using high‐resolution MR vessel wall imaging and found the most common etiology of ICAS was atherosclerosis (80.3%). The difference in prevalence of atherosclerotic disease between studies by Ahn et al.…”

“…() showed that moyamoya disease was the most dominant etiology of unilateral middle cerebral artery (MCA) stenosis in South Korean young adult patients with none or one atherosclerosis risk factor, followed by atherosclerosis, dissection, and vasculitis. However, a recent MR vessel wall imaging study reported that the most common etiology of ICAS in Chinese young patients with unilateral middle cerebral artery stenosis was ICAD (Xu et al., ). In addition, investigators have proved that MR vessel wall imaging is a reproducible technique (Qiao, Anwar et al., ; Qiao, Guallar et al., ), which can be reliably utilized to monitor the changes of ICAD during natural follow‐up or medical treatment.…”

High-resolution MRI of intracranial large artery diseases: how to use it in clinical practice?

“…The evidence from histological study of intracranial vessel wall lesions is very lacking. In a young patient with an intracranial concentric stenosis, it is not easy to establish the diagnosis if no clue from labwork is available 11. The pathophysiology of early asymptomatic intracranial atherosclerosis in young patients with traditional risk factors is unknown, which need further studies.…”