Intracranial Atherosclerosis

Leng, Xinyi; Liebeskind, David S

doi:10.1007/978-1-4614-9029-6_39

Cited by 2 publications

(3 citation statements)

References 49 publications

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“…Conversely, although noninvasive imaging methods such as CT or magnetic resonance perfusion imaging, or quantitative magnetic resonance angiography (MRA) could gauge whole-brain or territorial blood flow, these imaging methods could not directly quantify hemodynamic metrics such as intra-arterial pressure and WSS. 39,40 Therefore, CFD modeling based on noninvasive vascular imaging offers an approach to study the hemodynamics in cerebral arterial diseases. The current study was among the first longitudinal studies using this method to investigate the roles of hemodynamics in governing stroke risk in sICAS patients.…”

Section: Discussionmentioning

confidence: 99%

“…There have been reports measuring pressure gradient across sICAS lesions using pressure guidewire during performance of cerebral angiography in small case series; however, this could not be widely applied by far. Conversely, although noninvasive imaging methods such as CT or magnetic resonance perfusion imaging, or quantitative magnetic resonance angiography (MRA) could gauge whole‐brain or territorial blood flow, these imaging methods could not directly quantify hemodynamic metrics such as intra‐arterial pressure and WSS . Therefore, CFD modeling based on noninvasive vascular imaging offers an approach to study the hemodynamics in cerebral arterial diseases.…”

Section: Discussionmentioning

confidence: 99%

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Hemodynamics and stroke risk in intracranial atherosclerotic disease

Leng

Lan

et al. 2019

Annals of Neurology

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Objective: To investigate whether hemodynamic features of symptomatic intracranial atherosclerotic stenosis (sICAS) might correlate with the risk of stroke relapse, using a computational fluid dynamics (CFD) model. Methods: In a cohort study, we recruited patients with acute ischemic stroke attributed to 50 to 99% ICAS confirmed by computed tomographic angiography (CTA). With CTA-based CFD models, translesional pressure ratio (PR = pressure poststenotic /pressure prestenotic ) and translesional wall shear stress ratio (WSSR = WSS stenotic − throat /WSS prestenotic ) were obtained in each sICAS lesion. Translesional PR ≤ median was defined as low PR and WSSR ≥4th quartile as high WSSR. All patients received standard medical treatment. The primary outcome was recurrent ischemic stroke in the same territory (SIT) within 1 year. Results: Overall, 245 patients (median age = 61 years, 63.7% males) were analyzed. Median translesional PR was 0.94 (interquartile range [IQR] = 0.87-0.97); median translesional WSSR was 13.3 (IQR = 7.0-26.7). SIT occurred in 20 (8.2%) patients, mostly with multiple infarcts in the border zone and/or cortical regions. In multivariate Cox regression, low PR (adjusted hazard ratio [HR] = 3.16, p = 0.026) and high WSSR (adjusted HR = 3.05, p = 0.014) were independently associated with SIT. Patients with both low PR and high WSSR had significantly higher risk of SIT than those with normal PR and WSSR (risk = 17.5% vs 3.0%, adjusted HR = 7.52, p = 0.004). Interpretation: This work represents a step forward in utilizing computational flow simulation techniques in studying intracranial atherosclerotic disease. It reveals a hemodynamic pattern of sICAS that is more prone to stroke relapse, and supports hypoperfusion and artery-to-artery embolism as common mechanisms of ischemic stroke in such patients. ANN NEUROL 2019;85:752-764 I ntracranial atherosclerotic stenosis (ICAS) is a major cause of ischemic stroke in Asian populations, contributing to 30 to 50% of ischemic stroke and transient ischemic attack (TIA). 1,2 In earlier pivotal trials on treatment of symptomatic ICAS (sICAS) patients, such as the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial, risk of recurrent stroke and death was up to 15% at 1 year among those with 50 to 99% sICAS treated with aspirin. 3 In the last few years, risk of recurrent stroke in such patients has decreased with better cardiovascular risk factor management, but still higher than stroke patients without ICAS. For instance, among minor stroke or high-risk TIA patients treated with aspirin plus clopidogrel for 21 days followed by clopidogrel mono therapy for days 22 to 90 in the View this article online at wileyonlinelibrary.com.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hemodynamics and stroke risk in intracranial atherosclerotic disease

Leng

Lan

et al. 2019

Annals of Neurology

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“…Atherosclerosis is globally considered the most important risk factor for stroke [6]. Extracranial carotid arteries are often the first examined part of the vascular tree, where beginning or advanced atherosclerotic changes can be found.…”

Section: Introductionmentioning

confidence: 99%

Aortic Stiffness Is Independently Associated with Intracranial Carotid Artery Calcification in Patients with Ischemic Stroke

Gozdalski,

Nowicki,

Kwarciany

et al. 2023

Cerebrovasc Dis

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Introduction: Intracranial carotid artery calcification (ICAC), as a strong contributor to the occurrence of ischemic stroke, might be present in the medial or intimal arterial layer. Traditional cardiovascular risk factors (CVRFs) are associated with ICAC; however, its association with new markers of vascular function is less understood. The paper aimed to evaluate the relationship between carotid-femoral pulse wave velocity (CF-PWV) and ICAC subtypes. Methods: We enrolled 65 patients with ischemic stroke. CF-PWV, systolic, diastolic, mean blood pressure, and pulse pressure were measured within 6 ± 2 days after stroke onset, and CT was performed within 24 h. ICAC on the stroke site was classified by two methods: volume and score based. Tertiles of ICAC volume were determined, and low-grade ICAC (T1) was regarded as a reference. According to the score-based method, (dominant) medial and (dominant) intimal ICAC subtypes were determined. Data were analyzed with multivariate logistic regression. Results: Medial and intimal ICAC subtypes were found in 34 (52%) and 24 (37%) patients, respectively. In 11% of patients, no ICAC calcifications were found. CF-PWV was higher in patients with high-grade ICAC (OR = 1.56, 95% CI = 1.03–2.35, p = 0.035). CF-PWV was higher in patients with the medial ICAC subtype (OR = 1.60, 95% CI = 1.00–2.55, p = 0.049) after adjustment for traditional CVRFs. Conclusion: Our study demonstrates that among patients with ischemic stroke, aortic stiffness is independently associated with ICAC and that medial ICAC, compared with intimal ICAC, is accompanied by more advanced aortic stiffness.

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Intracranial Atherosclerosis

Cited by 2 publications

References 49 publications

Hemodynamics and stroke risk in intracranial atherosclerotic disease

Hemodynamics and stroke risk in intracranial atherosclerotic disease

Aortic Stiffness Is Independently Associated with Intracranial Carotid Artery Calcification in Patients with Ischemic Stroke

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